Early source control in sepsis.
OBJECTIVE
Early appropriate therapy in terms of early fluid resuscitation and early antibiotic therapy is beneficial in patients with severe sepsis and septic shock. The purpose of this review is to address the role of early source control in the management of patients with severe sepsis.


RESULTS
Establishing a clinical diagnosis as soon as possible is a prerequisite in patients with severe sepsis; in some cases, a surgical procedure can also serve as a diagnostic tool. Although source control is considered an essential element in the management of these patients, the definition and usefulness of early source control is not clear. Often, it is suggested that in non-severely ill patients, source control can be postponed up to 24 h, but this is related more to the lack of studies that demonstrate an advantage of early source control than to a sound pathophysiological rationale. Obstacles to early source control are numerous, but in most patients, there is little reason to delay source control for more than a few hours to allow preoperative optimization and correction of metabolic derangements. Finally, a three-level classification of urgency for source control measures is proposed. For every patient, the most appropriate method suited at that particular moment has to be chosen.


CONCLUSIONS
Source control is considered an essential element in the management of sepsis and should be considered and performed early after the diagnosis is established in most if not all patients.
Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium. Jan.DeWaele@UGent.be
Jan J
JJ
De Waele
D001064:Appendicitis / Q000150:complications / Q000601:surgery; D003646:Debridement; D019299:Decompression, Surgical; D020878:Device Removal; D004322:Drainage; D004630:Emergencies / Q000145:classification; D006801:Humans; D009336:Necrosis; D017410:Practice Guidelines as Topic; D018805:Sepsis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D018461:Soft Tissue Infections / Q000601:surgery; D013997:Time Factors