Sepsis: The evolution in definition, pathophysiology, and management

Abstract

There has been a significant evolution in the definition and management of sepsis over the last three decades. This is driven in part due to the advances made in our understanding of its pathophysiology. There is evidence to show that the manifestations of sepsis can no longer be attributed only to the infectious agent and the immune response it engenders, but also to significant alterations in coagulation, immunosuppression, and organ dysfunction. A revolutionary change in the way we manage sepsis has been the adoption of early goal-directed therapy. This involves the early identification of at-risk patients and prompt treatment with antibiotics, hemodynamic optimization, and appropriate supportive care. This has contributed significantly to the overall improved outcomes with sepsis. Investigation into clinically relevant biomarkers of sepsis are ongoing and have yet to yield effective results. Scoring systems such as the sequential organ failure assessment and Acute Physiology and Chronic Health Evaluation help risk-stratify patients with sepsis. Advances in precision medicine techniques and the development of targeted therapy directed at limiting the excesses of the inflammatory and coagulatory cascades offer potentially viable avenues for future research. This review summarizes the progress made in the diagnosis and management of sepsis over the past two decades and examines promising avenues for future research.

Modern Diagnostics of Sepsis and Septic Shock in Children

“…It should be noted that much has been done in the study of pediatric sepsis in recent years (60,61). In general, child mortality in the world has decreased significantly in recent years, including through the use of common methods of diagnosis and treatment confirmed by numerous studies (62).…”

Цитоэнергетическая И Пробиотическая Оптимизация Интенсивной Терапии Синдрома Гастроинтестинальной Недостаточности У Новорожденных: Оценка Клинической Эффективности

“…Зважаючи на екстрагастроінтестинальні впливи СГІН, можна стверджувати, що зменшення вираженості цього синдрому нівелювало ефекти, пов'язані із бактеріальною транслокацією з кишечника, зокрема прояви ССЗВ [23,24].…”

Establishing the Therapeutic Index of Fluid Resuscitation in the Septic Patient: A Narrative Review and Meta‐Analysis

“…The presence of sepsis or septic shock substantially alters the anticipated response to fluid therapy. Increased leukocyte adhesion and vasodilation causes significant degradation of endothelial and glycocalyx integrity, leading to a loss in the physiologic osmotic gradient . Because movement of fluid from the intravascular space (target of resuscitation) to the interstitial space depends on osmotic forces, vascular tone, capillary integrity, and the glycocalyx layer, septic patients are more prone to develop interstitial accumulation of fluids despite the therapeutic intent of intravascular volume expansion .…”

“…Increased leukocyte adhesion and vasodilation causes significant degradation of endothelial and glycocalyx integrity, leading to a loss in the physiologic osmotic gradient. 3,4 Because movement of fluid from the intravascular space (target of resuscitation) to the interstitial space depends on osmotic forces, vascular tone, capillary integrity, and the glycocalyx layer, septic patients are more prone to develop interstitial accumulation of fluids despite the therapeutic intent of intravascular volume expansion. 5 The net physiologic response from these inflammatory changes is higher relative interstitial and extracellular water volumes from capillary leak both before and during fluid resuscitation.…”