The New England Journal of MedicineSepsis and Septic Shock

Read the original article

Sepsis remains a significant global health challenge, affecting 48.9 million people and causing 11 million deaths annually. This comprehensive review examines current understanding of sepsis pathobiology, clinical presentation, management strategies, and long-term outcomes. The article highlights the evolution in sepsis definitions, treatment approaches, and emerging research directions while emphasizing the importance of prompt recognition and intervention.

Key Points:

• Global Impact: Sepsis accounts for over one-third of in-hospital deaths in the United States, with costs exceeding $38 billion in 2017. Approximately 85% of cases occur in low- and middle-income countries, with sub-Saharan Africa bearing 40% of the global burden.
• Clinical Recognition: Common infection sites include pulmonary (40-60%), abdominal (15-30%), and genitourinary (15-30%). Pathogens are identified in 60-70% of cases, with gram-positive and gram-negative bacteria being most common, followed by fungal and viral infections.
• Management Priorities: Treatment focuses on three key areas: infection control through appropriate antimicrobial therapy and source control, restoration of perfusion with careful fluid management (30 mL/kg initial resuscitation), and organ support. Balanced crystalloid solutions are preferred over normal saline.
• Treatment Evolution: Recent evidence supports permissive hypotension (MAP 60-65 mmHg) in older adults, and capillary refill-guided resuscitation shows promise compared to lactate-guided approaches. Stress-dose glucocorticoids benefit many patients with ongoing vasopressor requirements.
• Long-term Outcomes: Sepsis survivors face significant challenges, including cognitive impairment, functional limitations, and increased risk of readmission. Among previously employed survivors, 40% had not returned to work at 6 months post-sepsis.

HCN Medical Memo
Current sepsis management requires a balanced approach to resuscitation, with emerging evidence supporting more individualized MAP targets and fluid administration strategies. Success depends on early recognition, prompt intervention, and careful attention to both immediate treatment needs and long-term outcomes.

More on Sepsis