Perioperative treatment of patients with sepsis

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.

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.

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.