J Clin Outcomes Manage
The evolving treatment of sepsis
Liberman JD, Whelan CT
Abstract Objective: To review the literature related to recent advances in therapeutics for sepsis. Methods: MEDLINE and relevant proceedings of scientific meetings were searched to find pertinent meta-analyses and primary intervention trials related to the treatment of sepsis. Additional studies were identified by reviewing reference lists of selected articles. Results: Several new therapeutic interventions are effective at reducing morbidity and mortality among patients with sepsis. These interventions include early goal-directed therapy and administration of broad-spectrum antibiotics, treatment with hydrocortisone in the subset of septic patients with relative adrenal insufficiency, treatment with activated pro-tein C in patients with sepsis and high APACHE II scores or multisystem organ dysfunction, and intensive insulin therapy in surgical ICU patients with sepsis. Conclusions: Early goal-directed therapy has proven benefit among all patients initially presenting to the emergency department with sepsis. The other 3 ther-apies either have been studied in limited populations or have failed to show benefits in certain subpopulations. Early diagnosis and assessment of patients with sepsis is critical for initiating these new therapeutic options.
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