This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Wheeler, A. P. Search for Related Content PubMed PubMed Citation Articles by Wheeler, A. P. Related Content Recent Advances in Chest Medicine

Recent Developments in the Diagnosis and Management of Severe Sepsis^*

^* From the Medical Intensive Care Unit, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University, Vanderbilt Medical Center, Nashville, TN.

Correspondence to: Arthur P. Wheeler, MD, FCCP, Director, Medical Intensive Care Unit, Associate Professor of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University, T-1217 MCN Vanderbilt Medical Center, Nashville, TN 37232–250; e-mail: art.wheeler{at}vanderbilt.edu

Abstract

The last 5 years have brought dramatic changes to the care of patients with severe sepsis. While early diagnosis remains a challenge and, regrettably, a rapid, sensitive, and specific diagnostic test is still lacking, the methods to identify those critically ill patients who are likely to die have become clearer. The presence of multiple organ failure, vasopressor-dependent shock, and high values in formalized scoring methods such as the APACHE (acute physiology and chronic health evaluation) and sequential organ failure assessment systems all have some utility for outcome prediction for groups of patients. Refinements in long-used supportive practices such as lower tidal volume ventilation and enhanced glucose control have improved outcomes. A growing appreciation of the importance of timely provision of antimicrobial therapy, circulatory resuscitation, and activated protein C administration have also improved survival. Optimal treatment candidates for, and the timing and dose of some treatments (eg, corticosteroids) remain controversial and are undergoing additional study. Perhaps the most important change in the care of patients with severe sepsis is awareness that the syndrome is more common, lethal, and expensive, than previously appreciated, and as such it warrants an organized approach to care provided by experts. Although there is still much to learn, numerous studies now indicate that improvements in outcomes are possible when treatment protocols that incorporate all known beneficial therapies are applied in a timely fashion.

Key Words: ARDS • sepsis • septic shock • severe sepsis