Sepsis and Septic Shock

This issue of Seminars in Respiratory and Critical Care is focused on sepsis and septic shock. The mortality of sepsis and septic shock was already high before the coronavirus disease 2019 (COVID-19) pandemic, and it is likely that it got even worse during the pandemic because most hospitals worldwide have been overwhelmed with limiting intensive care unit resources, which are critical to treat patients with septic shock.

Takala et al discuss “Should vasopressors be started early in septic shock?” This has been a very important question for many decades because hypotension is the hallmark of septic shock; however, the cause of hypotension is multifactorial, thus it merits a multiprong approach in which the timing, monitoring, and magnitude of vasopressor initiation are critical for an adequate response to improve outcomes.

Montmollin et al ask “How antibiotics stewardship can be safely implemented in patients with septic shock?” While rapid initiation of antibiotics is essential to improve survival in septic shock, the excessive exposure of unnecessary antibiotic treatment can be detrimental to both patients and public health, so a rational utilization and safe de-escalation are key to optimally treat the infection source in patients with septic shock.

Sweeney et al approach the “Integrated multiorgan bedside ultrasound for the diagnosis and management of sepsis and septic shock.” The authors made the case for the utilization of bedside ultrasound techniques to improve the clinician's ability to diagnose and treat patients with sepsis. They review the literature and provide support for the use of this technology to improve the hemodynamic management.

Agarwal et al ask the question “Any role of high-dose vitamin C for septic shock in 2021?” Vitamin C has been tried as a potential therapy for multiple diseases for over a half-century, and more recently has been evaluated in patients with sepsis and septic shock. The authors reviewed the several completed randomized trials and concluded that the current evidence does not support the use of vitamin C in patients with sepsis or septic shock.

Nedel et al address “What is the role of steroids for septic shock in 2021?” Although steroids have been used for many years in the treatment of septic shock, the randomized trials have not produced consistent benefits, particularly regarding survival. The authors provide a comprehensive review of the subject and guidance for future studies.

Weiberger et al ask “What is the utility of measuring lactate levels in patients with sepsis and septic shock? Blood lactate has been used to diagnose and guide treatment of septic shock, but both the biology and clinical evidence to support the use of lactate are complex and controversial. The authors make a critical assessment of the literature and make recommendations on how to avoid its overuse and unintended consequences.

Florescu et al address “Survival outcome of sepsis in recipients of solid organ transplant.” The authors provide an extensive review of the subject, which shows important new evidence that is relevant for both the diagnosis and treatment of sepsis in organ transplant recipients, and also provide an update on the effect of new biomarkers.

Plata-Manchaca et al discuss the “Evidence for the application of sepsis bundles in 2021.” The authors describe the issues related to quality-of-care improvements and use of bundles and suggest that this approach has improved survival and needs to continue being refined according to emergent evidence.

Ravi et al talk about “Optimizing fluid resuscitation and preventing fluid overload with septic shock.” The authors describe the danger of fluid overload when the bedside assessment is not accurate and emphasize the need for a more dynamic approach to assess fluid responsiveness to improve outcomes.

Povoa et al discuss “Which biomarkers can be used as diagnostic tools for infection in suspected sepsis?” The diagnosis of sepsis remains complex and prone to mistakes; thus, the authors review the potential utilization of different biomarkers to both diagnose and target treatment in sepsis and suggested that more research is needed to find the ideal biomarker.

In conclusion, this edition brings together a group of experts in the field and provides a comprehensive and critical review of subjects directly relevant to the bedside diagnosis and treatment of patients with sepsis and septic shock.

Publication History

Article published online:
20 September 2021