title: Perioperative treatment of patients with sepsis.
abstract: OBJECTIVE
  Key elements in the initial resuscitation and stabilization of the patient with sepsis are fluid therapy, vasopressor or inotropic support, administration of adequate antibiotics and source control. This review will primarily discuss fluid, vasopressor and antibiotic therapy because these have been the subject of the recent large clinical trials.
  
  
  RESULTS
  On the basis of the recent large randomized clinical trials, starch solutions should be avoided in patients with sepsis because there is no evidence of benefit and clear signals of harm including adverse effects on kidney and haemostatic function and increased mortality in one trial. Ongoing trials are investigating the efficacy and safety of albumin and red blood cell transfusion in patients with sepsis. Norepinephrine should be the first-line vasopressor agent because accumulating evidence shows more adverse events with the use of dopamine. Early initiation of adequate antibiotic therapy is recommended and etomidate should not be used in patients with sepsis.
  
  
  CONCLUSIONS
  Recent high-quality trials in the intensive care setting have provided data to improve the treatment and thereby the outcome of patients with sepsis. These findings may be used in the perioperative setting to minimize the harmful effects of specific interventions.
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Ibsen
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
mesh_terms: D000777:Anesthetics; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005440:Fluid Therapy; D006040:Goals; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D018805:Sepsis / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000777:Anesthetics; D000900:Anti-Bacterial Agents; D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents