Sepsis continues to be a common and serious problem among surgical patients. It is a leading cause of both morbidity and mortality in the perioperative period. The early identification of sepsis and the early implementation of evidence-based care can improve outcomes. This focused review will identify ways to improve the early identification of sepsis and discuss the current evidence-based guidelines for the early management of sepsis, severe sepsis, and septic shock in the surgical patients.
DombrovskiyVYMartinAASunderramJPazHL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35(5):1244–1250.
2.
DombrovskiyVYMartinAASunderramJPazHL. Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations. Crit Care Med. 2005;33(11):2555–2562.
3.
AngusDCLinde-ZwirbleWTLidickerJClermontGCarcilloJPinskyMR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–1310.
4.
MooreLJMooreFAJonesSLXuJBassBL. Sepsis in general surgery: a deadly complication. Am J Surg. 2009;198(6):868–874.
5.
BalkRABoneRC. The septic syndrome. Definition and clinical implications. Crit Care Clin. 1989;5(1):1–8.
6.
. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 1992;20(6):864–874.
7.
LevyMMFinkMPMarshallJC. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29(4):530–538.
8.
RiversENguyenBHavstadS. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–1377.
9.
KumarARobertsDWoodKE. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–1596.
10.
RobsonWBeavisSSpittleN. An audit of ward nurses' knowledge of sepsis. Nurs Crit Care. 2007;12(2):86–92.
11.
PoezeMRamsayGGerlachHRubulottaFLevyM. An international sepsis survey: a study of doctors' knowledge and perception about sepsis. Crit Care. 2004;8(6):R409–R413.
12.
SucherJFMooreFAToddSRSailorsRMMcKinleyBA. Computerized clinical decision support: a technology to implement and validate evidence based guidelines. J Trauma. 2008;64(2):520–537.
13.
MooreLJJonesSLKreinerLA. Validation of a screening tool for the early identification of sepsis. J Trauma. 2009;66(6):1539–1546; discussion 1546-1547.
14.
SebatFJohnsonDMusthafaAA. A multidisciplinary community hospital program for early and rapid resuscitation of shock in nontrauma patients. Chest. 2005;127(5):1729–1743.
15.
ShorrAFMicekSTJacksonWLKollefMH. Economic implications of an evidence-based sepsis protocol: can we improve outcomes and lower costs?Crit Care Med. 2007;35(5):1257–1262.
16.
NguyenHBCorbettSWSteeleR. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007;35(4):1105–1112.
17.
ShapiroNIHowellMDTalmorD. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med. 2006;34(4):1025–1032.
18.
MicekSTRoubinianNHeuringT. Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med. 2006;34(11):2707–2713.
19.
MooreLJTurnerKLToddSRMcKinleyBMooreFA. Computerized clinical decision support improves survival in intra abdominal surgical sepsis. Am J Surg. 2010;200(6):839–843; discussion 843-844.
20.
FinferSBellomoRBoyceN. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247–2256.
21.
BendjelidKRomandJ. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med. 2003;29(3):352–360.
22.
VarpulaMTallgrenMSaukkonenKVoipio-PulkkiLPettiläV. Hemodynamic variables related to outcome in septic shock. Intensive Care Med. 2005;31(8):1066–1071.
23.
RiversENguyenBHavstadS. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–1377.
24.
JonesAEShapiroNITrzeciakS. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739–746.
25.
KortgenANiederprümPBauerM. Implementation of an evidence-based “standard operating procedure” and outcome in septic shock. Crit Care Med. 2006;34(4):943–949.
26.
ShapiroNIHowellMDTalmorD. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med. 2006;34(4):1025–1032.
27.
TrzeciakSDellingerRPAbateNL. Translating research to clinical practice: a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department. Chest. 2006;129(2):225–232.
28.
MesquidaJMasipJGiliGArtigasABaigorriF. Thenar oxygen saturation measured by near infrared spectroscopy as a noninvasive predictor of low central venous oxygen saturation in septic patients. Intensive Care Med. 2009;35(6):1106–1109.
29.
SakrYReinhartKVincentJ. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med. 2006;34(3):589–597.
30.
De BackerDBistonPDevriendtJ. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779–789.
31.
LandryDWLevinHRGallantEM. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation. 1997;95(5):1122–1125.
32.
RussellJA. Vasopressin in vasodilatory and septic shock. Curr Opin Crit Care. 2007;13(4):383–391.
33.
RussellJAWalleyKRSingerJ. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358(9):877–887.
34.
RussellJAWalleyKRGordonAC. Interaction of vasopressin infusion, corticosteroid treatment, and mortality of septic shock. Crit Care Med. 2009;37(3):811–818.
35.
HolmesCLWalleyKRChittockDRLehmanTRussellJA. The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med. 2001;27(8):1416–1421.
36.
ArpiMBentzonMWJensenJFrederiksenW. Importance of blood volume cultured in the detection of bacteremia. Eur J Clin Microbiol Infect Dis. 1989;8(9):838–842.
37.
MermelLAMakiDG. Detection of bacteremia in adults: consequences of culturing an inadequate volume of blood. Ann Intern Med. 1993;119(4):270–272.
38.
BouzaESousaDRodríguez-CréixemsMLechuzJGMuñozP. Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections?J Clin Microbiol. 2007;45(9):2765–2769.
39.
BlotFSchmidtENitenbergG. Earlier positivity of central-venous- versus peripheral-blood cultures is highly predictive of catheter-related sepsis. J Clin Microbiol. 1998;36(1):105–109.
40.
BlotFNitenbergGChachatyE. Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet. 1999;354(9184):1071–1077.
41.
KregerBECravenDEMcCabeWR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980;68(3):344–355.
42.
IbrahimEHShermanGWardSFraserVJKollefMH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118(1):146–155.
43.
LeiboviciLShragaIDruckerM. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med. 1998;244(5):379–386.
44.
FitousisKMooreLJHallJMooreFAPassS. Evaluation of empiric antibiotic use in surgical sepsis. Am J Surg. 2010;200(6): 776–82.
45.
GaieskiDFMikkelsenMEBandRA. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med. 2010;38(4):1045–1053.
46.
KumarAEllisPArabiY. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136(5):1237–1248.
47.
LevyMMDellingerRPTownsendSR. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367–374.
48.
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416.
49.
SolomkinJSMazuskiJEBradleyJS. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin. Infect. Dis. 2010;50(2):133–164.
CuéJICryerHGMillerFBRichardsonJDPolkHC. Packing and planned reexploration for hepatic and retroperitoneal hemorrhage: critical refinements of a useful technique. J Trauma. 1990;30(8):1007–1011; discussion 1011-1013.
52.
RotondoMFSchwabCWMcGonigalMD. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35(3):375–382; discussion 382-383.
53.
BurchJMOrtizVBRichardsonRJ. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215(5):476–483; discussion 483-484.
54.
de MoyaMADunhamMInabaK. Long-term outcome of acellular dermal matrix when used for large traumatic open abdomen. J Trauma. 2008;65(2):349–353.
55.
GarnerGBWareDNCocanourCS. Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomens. Am J Surg. 2001;182(6):630–638.
56.
SuliburkJWWareDNBaloghZ. Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma. J Trauma. 2003;55(6):1155–1160; discussion 1160-1161.
57.
MillerPRThompsonJTFalerBJMeredithJWChangMC. Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. J Trauma. 2002;53(5):843–849.
58.
CothrenCCMooreEEJohnsonJLMooreJBBurchJM. One hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg. 2006;192(2):238–242.
59.
BaloghZMcKinleyBACoxJr CS. Abdominal compartment syndrome: the cause or effect of postinjury multiple organ failure. Shock. 2003;20(6):483–492.
60.
CothrenCCMooreEEJohnsonJLMooreJB. Outcomes in surgical versus medical patients with the secondary abdominal compartment syndrome. Am J Surg. 2007;194(6):804–807; discussion 807-808.
61.
McNelisJMariniCPJurkiewiczA. Predictive factors associated with the development of abdominal compartment syndrome in the surgical intensive care unit. Arch Surg. 2002;137(2):133–136.
62.
MalbrainMLNGChiumelloDPelosiP. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33(2):315–322.
63.
TurnerKLMooreLJSucherJFToddSRMcKinleyBASailorsRMMooreFA. Damage Control Laparotomy: Beyond Trauma. Poster presented at the 68th Annual Meeting of the American Association for the Surgery of Trauma. 2009; Pittsburg, PA, 1-3.
64.
AnnaneDSébilleVCharpentierC. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862–871.
65.
AnnaneDBellissantEBollaertPE. Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis. BMJ. 2004;329(7464):480.
66.
MinneciPCDeansKJBanksSMEichackerPQNatansonC. Meta-analysis: the effect of steroids on survival and shock during sepsis depends on the dose. Ann Intern Med. 2004;141(1):47–56.
67.
SprungCLAnnaneDKehD. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358(2):111–124.
68.
DellingerRPLevyMMCarletJM. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327.
69.
BariePSHydoLJShouJEachempatiSR. Efficacy and safety of drotrecogin alfa (activated) for the therapy of surgical patients with severe sepsis. Surg Infect (Larchmt). 2006;7(suppl 2):S77–S80.
70.
DellingerRPCarletJMMasurH. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32(3):858–873.
71.
HollenbergSMAhrensTSAnnaneD. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med. 2004;32(9):1928–1948.
72.
BerenholtzSMPronovostPJNgoK. Developing quality measures for sepsis care in the ICU. Jt Comm J Qual Patient Saf. 2007;33(9):559–568.
73.
GaoFMelodyTDanielsDFGilesSFoxS. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Crit Care. 2005;9(6):R764–R770.
74.
McKinleyBAMooreFASailorsRM. Computerized decision support for mechanical ventilation of trauma induced ARDS: results of a randomized clinical trial. J Trauma. 2001;50(3):415–424; discussion 425.
75.
SantoraRJMcKinleyBAMooreFA. Computerized clinical decision support for traumatic shock resuscitation. Curr Opin Crit Care. 2008;14(6):679–684.
76.
MooreLJMooreFAToddSRJonesSLTurnerKLBassBL. Sepsis in general surgery: the 2005-2007 national surgical quality improvement program perspective. Arch Surg. 2010; 145(7):695–700.