title: Current controversies in the support of sepsis.
abstract: OBJECTIVE
  Sepsis has a high morbidity, with a mortality rate of over 50% in the septic shock patient. This review provides a comprehensive summary of the latest Surviving Sepsis Campaign and the recent evidence since its publication. The guidelines reflect literature from the past 5 years to optimize outcomes in patients with severe sepsis and septic shock.
  
  
  RESULTS
  The most relevant changes in the latest Surviving Sepsis Campaign include the use of a protocolized resuscitation with specific physiologic targets, preference of crystalloids for volume resuscitation, preferential use of norepinephrine as the initial vasopressor, addition of lactate and its clearance as a marker of tissue hypoperfusion, reduced emphasis on corticosteroids, and removal of activated protein C therapy. Since these latest guidelines, there have been many trials published to address the various measures that are advocated. We review the recent data on fluid resuscitation, targets of resuscitation, vasopressors, and trials of protocolized care versus usual care.
  
  
  CONCLUSIONS
  Severe sepsis remains a significant cause of morbidity and mortality in hospitalized patients. The International Surviving Sepsis Guidelines provide a framework for early recognition and treatment of this condition, with the goal of an improved outcome and mortality in severe sepsis. The recent evidence suggests that early identification, adequate volume resuscitation, and assessment of adequate circulation may be the key elements to decrease morbidity from severe sepsis and septic shock.
authors.affiliation: Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, and Division of Pulmonary Critical Care Medicine, Department of Medicine, Winthrop-University Hospital, Mineola, New York, USA.
authors.forename: Shalinee
authors.initials: S
authors.lastname: Chawla
authors.forename: Jonas P
authors.initials: JP
authors.lastname: DeMuro
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D017408:Guidelines as Topic; D006760:Hospitalization; D006801:Humans; D058996:Quality Improvement; D018805:Sepsis / Q000188:drug therapy / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents