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Semin Respir Crit Care Med 2022; 43(01): 039-045
DOI: 10.1055/s-0041-1740975
Review Article

Sepsis and Septic Shock: Evolving Evidence, Evolving Paradigms

Andrew F. Shorr
1   Section of Pulmonary and Critical Care Medicine (AFS), MedStar Washington Hospital Center, Washington, District of Columbia
,
Marya D. Zilberberg
2   Evimed Research, Goshen Massachusetts
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Abstract

Sepsis and septic shock represent important infection-related medical emergencies that result in significant morbidity and mortality. The prevalence and microbiology of these processes are evolving. Nonetheless, timely and appropriate antibiotic therapy continues to represent the most important determinant of survival. Recent trials have clarified that crystalloids are preferred for initial resuscitation, and balanced crystalloids appear superior to 0.9% saline. Controversy remains regarding not only the rate and rapidity of fluid resuscitation but also about the timing and use of vasopressors to maintain blood pressure. While some newer alternative vasopressors may have a role in sepsis, more evidence supporting their use is required. Conflicting data exist regarding the impact of corticosteroids on mortality in septic shock. However, these reports indicate that adjunctive hydrocortisone can lead to more rapid shock reversal.

Keywords

antibiotics - corticosteroids - fluids - sepsis - resuscitation - vasopressors


Publication History

Article published online:
16 February 2022

© 2022. Thieme. All rights reserved.

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