Current standard of care for septic shock

Sepsis is a syndrome of life-threatening organ dysfunction that results from dysregulated host response to infection, with septic shock defined as persistent hypotension despite fluid resuscitation, a serum lactate > 2 mmol/L and the need for a vasopressor infusion to maintain a mean arterial pressure of at least 65 mmHg. Approximately, 49 million cases of sepsis are recorded worldwide annually, with 11 million sepsis-related deaths, the majority occurring in patients with septic shock. A substantial proportion of survivors suffer from moderate to severe functional limitations including physical, cognitive and psychological disability, exacerbation of pre-existing chronic conditions and a high incidence of re-hospitalisation in the first 12 months after the initial diagnosis. Optimal management of patients with septic shock requires prompt and reliable recognition of patients with sepsis who require additional haemodynamic support. Initially, patients will need judicious intravenous fluids and consideration of the need for vasopressors such as norepinephrine. Administration of appropriate antibiotics and consideration for control of the source of infection are also required. In the optimisation phase, depending on patients' comorbidities and response to therapy, the balance of fluid therapy, vasopressors and potentially the addition of an inotropic agent will need to be adjusted, based on clinical findings and haemodynamic and biochemical parameters. For those patients who do not respond to initial therapy, more intensive monitoring may be required with consideration of adjunctive therapies such as corticosteroids, vasopressin, angiotensin II or other rescue therapies to achieve cardiovascular stability. Once stability has been achieved, clinicians need to consider strategies to ameliorate the potential long-term effects on survivors, while keeping in mind the perspective and experience of their patients.