Sepsis: frontiers in diagnosis, resuscitation and antibiotic therapy.
Sepsis is a major growing global burden and a major challenge to intensive care clinicians, researchers, guideline committee members and policy makers, because of its high and increasing incidence and great pathophysiological, molecular, genetic and clinical complexity. In spite of recent progress, short-term mortality remains high and there is growing evidence of long-term morbidity and increased long-term mortality in survivors of sepsis both in developed and developing countries. Further improvement in the care of patients with sepsis will impact upon global health. In this narrative review, invited experts describe the expected challenges and progress to be made in the near future. We focus on diagnosis, resuscitation (fluids, vasopressors, inotropes, blood transfusion and hemodynamic targets) and infection (antibiotics and infection biomarkers), as these areas are key, if initial management and subsequent outcomes are to be improved in patients with sepsis.
Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. anders.perner@regionh.dk.
Anders
A
Perner
Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK.
Anthony C
AC
Gordon
Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium.
Daniel
D
De Backer
Department of Critical Care, University Hospital ATTIKON, Medical School, University of Athens, Athens, Greece.
George
G
Dimopoulos
Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
James A
JA
Russell
Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD, Australia.
Jeffrey
J
Lipman
CHIP and PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Jens-Ulrik
JU
Jensen
The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
John
J
Myburgh
Division of Medicine, Bloomsbury Institute of Intensive Care Medicine, University College London, London, WC1E 6BT, UK.
Mervyn
M
Singer
School of Medicine, The University of Melbourne, Melbourne, VIC, Australia.
Rinaldo
R
Bellomo
Anaesthetics, Critical Care, and Pain Medicine, Edinburgh University, Edinburgh, Scotland, UK.
Timothy
T
Walsh
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003422:Critical Care / Q000592:standards*; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D012151:Resuscitation; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents
Antibiotic; Critical care; Intensive care; Sepsis; Shock
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