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.