Trends and controversies in the management of sepsis

Patients with sepsis are frequently encountered in emergency departments and hospital wards, but may be at different stages of the disease process. In the UK, Intensive Care National Audit and Research Centre data collected in 2005 estimated that 36 800 patients per year die of sepsis, more than the annual mortality from breast cancer and bowel cancer combined (Daniels, 2007). International guidelines were published in 2004 and updated in 2008 (Dellinger et al, 2008) aiming to improve outcomes from sepsis syndromes through promotion of evidence-based practice. While components of the guidelines continue to be the subject of debate, prompt appropriate action will have the greatest impact on mortality and morbidity. This article gives a practical, evidencebased approach to the early management of the septic patient and outlines some areas of controversy.