Remember, the enigmatic "sepsis" fits within a spectrum of disease:
1) SIRS (systematic inflammatory response syndrome) = at least 2 of a) temperature >38.3ºC or <36ºC, b) pulse >90 bpm, c) RR>20 breaths/min or PaCO2<32 mmHg, and d) WBC>12 or <4
2) Sepsis = SIRS + source of infection
3) Severe sepsis = Sepsis + end-organ dysfunction (including CNS, renal, cardiac, respiratory, hematologic)
4) Septic shock = Severe sepsis + inability to respond to adequate fluid resuscitation
The "Surviving Sepsis Campaign" is an international campaign designed to raise awareness and streamline the management of this important syndrome, which still carries with it a 30-day mortality rate of approximately 30%.
Click on this link for the full set of guidelines published in Critical Care Medicine in 2008, and on this link for the handy-dandy pocket guide.
These Guidelines are based, in part, upon the "Rivers Protocol" or Early-Goal Directed Therapy, published in NEJM in 2001. Click here to read this seminal paper.
In addition to these important hemodynamic parameters, we must not forget about treating the source of sepsis. This typically means identification of the source of infection and early and appropriate broad-spectrum antibiotics (within one-hour of identification of severe sepsis, and ideally after cultures have been drawn) +/- source control.
