Premium
Review article: Sepsis in the emergency department – Part 3: Treatment
Author(s) -
Williams Julian M,
Keijzers Gerben,
Macdonald Stephen PJ,
Shetty Amith,
Fraser John F
Publication year - 2018
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12951
Subject(s) - medicine , sepsis , intensive care medicine , septic shock , guideline , audit , psychological intervention , emergency department , vasopressin , surviving sepsis campaign , shock (circulatory) , procalcitonin , antibiotics , severe sepsis , surgery , nursing , management , pathology , microbiology and biotechnology , economics , biology
Although comprehensive guidelines for treatment of sepsis exist, current research continues to refine and revise several aspects of management. Imperatives for rapid administration of broad‐spectrum antibiotics for all patients with sepsis may not be supported by contemporary data. Many patients may be better served by a more judicious approach allowing consideration of investigation results and evidence‐based guidelines. Conventional fluid therapy has been challenged with early evidence supporting balanced, restricted fluid and early vasopressor use. Albumin, vasopressin and hydrocortisone have each been shown to support blood pressure and reduce catecholamine requirements but without effect on mortality, and as such should be considered for ED patients with septic shock on a case‐by‐case basis. Measurement of quality care in sepsis should incorporate quality of blood cultures and guideline‐appropriateness of antibiotics, as well as timeliness of therapy. Local audit is an essential and effective means to improve practice. Multicentre consolidation of data through agreed minimum sepsis data sets would provide baseline quality data, required for the design and evaluation of interventions.