[Treatment of severe sepsis and septic shock]

The 3 poles of treatment. These are the hemodynamic management, early antibiotherapy and more specific treatments, based on improved physiopathological knowledge. From a hemodynamic point of view The first stage must always be to detect and correct the hypovolemia. The administration of vasopressive amines (or vasoconstricting amines) is mandatory in the case of septic shock. The choice of the antibiotics In the absence of microbiological proof, it is based on the germs most often encountered in infections of the suspected site and community or nosocomial nature of the infection. The antibiotherapy must be set-up as early as possible once the bacteriological samples have been. Treatments based on the physiopathology The activated protein C possesses pro-fibrinolytic, anticoagulant and anti-inflammatory properties; it obtained marketing Authorization in Europe for patients with severe sepsis and at least 2 organ failures or hypotension. Low-dose corticosteroids should be prescribed in the case of septic shock with prolonged use of catecholamines, and if possible following a test with Synacthène(R) (relative adrenal insufficiency). Intensive insulin therapy is aimed at maintaining normal glycemia in the patients for as long as possible.