Sepsis - What's new in 2019?

Current Opinion in Anaesthesiology
Mark E Nunnally, Arpit Patel

Abstract

Sepsis-3 guidelines have implications in a deeper understanding of the biopathology of the disease. Further, the review focuses on timely topics and new literature on fluid resuscitation, the value of steroids in sepsis, and new therapeutic options such as angiotensin II, vitamin C, and thiamine as well as the emerging role of procalcitonin (PCT) in managing antibiotics. Traditional therapies such as type of crystalloid fluid administration and steroid therapy for sepsis are currently under re-evaluation. Angiotensin II is investigated for reversing vasodilatory shock. The role of capillary endothelium leak and cellular metabolism can be affected by vitamin C and thiamine levels. Biomarker level trends, specifically PCT, can aid clinical suspicion of infection. Sepsis-3 shifts the focus from a noninfectious inflammatory process and an emphasis on a dysregulated host response to infection. Hyperchloremic crystalloid resuscitation is associated with poor clinical outcomes. Steroid administration can reverse shock physiology; however, mortality benefits remain uncertain. Angiotensin II, vitamin C, and thiamine are novel treatment options that need further validation. PCT assays can help discern between infectious and noninfectious...Continue Reading

References

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Citations

Nov 2, 2019·International Journal of Molecular Sciences·Min HuangJingqian Su
Nov 16, 2019·Panminerva Medica·Alberto TosoniUNKNOWN Internal Medicine Sepsis Study Group
Mar 7, 2020·Blood·Shadi Swaidani, Keith R McCrae
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Dec 10, 2020·Journal of Intensive Care·Xiaomin ShenYunqing Qiu
Nov 20, 2020·Expert Review of Anti-infective Therapy·Klaus BrandenburgPatrick Garidel
May 7, 2021·BioMed Research International·Ying WangShiquan Liu

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