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Critical Care  2004 

The challenge of sepsis

DOI: 10.1186/cc3009

Keywords: diagnosis, management, sepsis, surviving sepsis campaign

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Abstract:

Taken together, these findings identify the challenges most clinicians face when dealing with sepsis in the intensive care unit, namely how best to identify these patients, when to initiate treatment, how to monitor the progress (both resolution and deterioration) of the disease, and how to communicate with patients and families about the nature of one of the most common diseases in critically ill patients.In the past the need for clinicians to identify and stage critically ill patients with sepsis at the bedside was less important than it is today. Until recently few interventions were available to clinicians that may improve survival in patients critically ill with severe sepsis or septic shock. For many years, the only interventions of proven value in the treatment of patients with sepsis were early institution of appropriate antibiotics, adequate resuscitation, and, finally, good source control [3,4]. These interventions were and continue to be fundamental components of management for critically ill patients with sepsis. However, these interventions, although of obvious importance, were applicable to all patients with infection. They were not specific to patients with sepsis, severe sepsis, or septic shock. Therefore, the need to identify and stage patients with sepsis was of little clinical importance, and there was no impetus for the bedside clinician to value a staging system for sepsis. This almost certainly has fostered confusion, expressed by the survey respondents, regarding clear definitions of sepsis.It is important to note that each of the issues raised by respondents in the survey has been addressed in the literature over the past several years. These have led to significant changes in the way in which diagnosis and treatment of sepsis in critically ill patients should be approached.In response to this survey, conducted in 2001, an international sepsis definitions conference, sponsored by several international critical care societies, was convened in

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