Sepsis 2021: a review

Sepsis is responsible for tremendous morbidity, mortality and health-care expenditure worldwide. Over the past decade, the conceptualization of sepsis has shifted from one based upon an inflammatory response to one defined by a dysregulated immune response to infection and resulting organ dysfunction. The definitions of sepsis and septic shock were revised to improve their diagnostic specificity and facilitate accurate and timely diagnoses at the bedside. The core of sepsis management remains early identification and diagnostic testing, early antimicrobial therapy, and early haemodynamic resuscitation. Current guidelines recommend that the first steps in treatment and resuscitation should take place within 1 hour from when sepsis is suspected. Additional essential elements in the current sepsis management guidelines include using dynamic parameters to assess fluid responsiveness, a conservative fluid strategy following initial resuscitation (with ‘de-resuscitation’ when possible), serial re-assessments of haemodynamic status and adaptable treatment plans. This article provides a summary of the most recent clinical evidence and professional guidelines for the diagnosis and treatment of sepsis in the critical care setting.