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Standard care of the patient with severe sepsis consists of a number of medical (and sometimes surgical) interventions intended to normalize physiology and eliminate infection. These are divided into:
  • Source control: This term refers to management of the source of the infection. It can consist of surgery to drain an abscess or removal of an infected catheter.
  • Antibiotics: While the initial therapy may be broad-based and empiric, identification of the specific pathogen by microbiologic studies may result in a switch of the antibiotic to those that are the most specific and bacteriocidal.
  • Hemodynamic support: This term refers to volume replenishment therapy followed, when necessary, by appropriate use of drugs such as norepinephrine to maintain blood pressure and organ perfusion.
  • Mechanical ventilation: Respiratory failure is a common manifestation of pulmonary organ dysfunction in patients with severe sepsis. Mechanical ventilation is instituted to increase oxygenation and improve gas exchange.
  • Renal replacement therapy: Impaired renal function is a sign of organ dysfunction in patients with severe sepsis. Renal replacement therapy consists of temporary hemodialysis or ultrafiltration.
  • Sedation and analgesia: Sedation is often required to treat anxiety and agitation in patients with severe sepsis. Because these patients are at risk for pain and physical discomfort, analgesics also are commonly employed.
  • Ensure adequate nutrition: Sepsis is a hypercatabolic state. Therefore, caloric and nitrogen requirements should be met and enteral nutrition provided in a timely fashion.
  • Provide hematological support: Critically ill patients may require packed red blood cells, platelets, and coagulation factors.
  • Other supportive measures: These include measures to prevent deep venous thrombosis, stress ulcer prophylaxis, etc.
  • Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med. 1999;340:207-14.