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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.
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