The decision-making process in sepsis and septic shock

Despite dedicated attention and research, sepsis continues to be problematic in surgical patients. Sepsis and septic shock are ten times more frequent and have a higher associated mortality in surgical patients compared with perioperative myocardial infarction and pulmonary embolism. When septic shock occurs in surgical patients, it has an associated mortality of 39 % in emergent cases and 30 % in elective cases. Recent evidence-based advancement in critical care practices have led to a decrease in the case fatality rate for severe sepsis. These include the implementation of a screening program for early sepsis identification, prompt administration of antimicrobials, and obtaining surgical source control. Particularly in surgical patients, using Systemic Inflammatory Response Syndrome (SIRS) criteria to screen for sepsis has proven impractical and insensitive; screening programs designed specifically for surgical patients should be used instead. While the individual components of early goal-directed therapy have been recently disputed, early recognition remains paramount in importance for improving survival from sepsis and septic shock.