Management of Septic Shock: Current Concepts

Despite the availability of potent antibiotics and a myriad of investigational agents directed against inflammatory mediators, septic shock has remained the most common cause of mortality in the intensive care unit. However, substantial progress has been made in our understanding of the pathophysiology, clinical staging, diagnosis and risk assessment of sepsis and septic shock. Currently, early goal-directed resuscitation and monitoring for haemodynamic support, prompt diagnosis, and effective control of the source of infection has remained the mainstay of management. In this article, the current concepts of the pathophysiology, clinical staging and empirical choice of antibiotics in sepsis and septic shock are briefly reviewed, and the rationale and indications for the use of activated protein C, replacement doses of corticosteroids, and other investigational immunotherapies in severe sepsis and septic shock are discussed.