Paper Presented at 42nd annual Conference of Maharashtra State Chapter of ASI ( MASICON 2020) in Amravati on 24 January 2020. ) Abstract: Background: Septic shock remains a leading cause of mortality despite advances in critical care. Recent updates and guidelines have shifted clinical approaches to improve recognition and management. This review highlights the role of various clinical tools, interventions, and therapeutic strategies in managing septic shock. Objective: To examine the current clinical strategies and guidelines in recognizing and treating septic shock, with emphasis on occult septic shock, fluid resuscitation, vasopressor usage, and the role of steroids, lactate monitoring, and procalcitonin in prognosis. Methods: A comprehensive review of the literature, including the latest guidelines from the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), the Surviving Sepsis Campaign, and retrospective studies comparing clinical tools such as SIRS, qSOFA, and NEWS for early identification of septic shock. Results: 1. Recognition of Septic Shock: - SIRS, qSOFA, and NEWS were evaluated, with NEWS emerging as a more accurate tool for early recognition. - Lactate and procalcitonin are valuable markers but have limitations in predicting patient outcomes.2. Resuscitation Strategies: - Ringer's Lactate is preferred over saline for initial resuscitation due to the latter’s association with hyperchloremic acidosis. - The recommended fluid resuscitation strategy includes rapid administration of 30mL/kg crystalloid for hypotension or lactate > 4 mmol/L.3. Vasopressor and Steroid Use: - Early norepinephrine administration is recommended to maintain a MAP > 65 mmHg. - Vasopressin is the second-line vasopressor, though its benefits in reducing mortality are uncertain. - Steroids, particularly in conjunction with vitamin C and thiamine, may improve outcomes in vasopressor-refractory septic shock.4. Antibiotic Timing and Administration: - Early antibiotic administration, ideally within one hour of sepsis diagnosis, significantly improves survival rates. Conclusion: Effective management of septic shock involves early recognition using appropriate clinical tools like NEWS, aggressive fluid resuscitation with balanced crystalloids, timely initiation of vasopressors, and careful consideration of steroids and antibiotics. Further large-scale randomized controlled trials are needed to refine these approaches, particularly in vasopressor and steroid administration.

This book is open access under a CC BY 4.0 license. It constitutes a unique source of knowledge and guidance for all healthcare workers who care for patients with sepsis and septic shock in resource-limited settings. More than eighty percent of the worldwide deaths related to sepsis occur in resource-limited settings in low and middle-income countries. Current international sepsis guidelines cannot be implemented without adaptations towards these settings, mainly because of the difference in local resources and a different spectrum of infectious diseases causing sepsis. This prompted members of the Global Intensive Care working group of the European Society of Intensive Care Medicine (ESICM) and the Mahidol-Oxford Tropical Medicine Research Unit (MORU, Bangkok, Thailand) - among which the Editors – to develop with an international group of experts a comprehensive set of recommendations for the management of sepsis in resource-limited settings. Recommendations are based on both current scientific evidence and clinical experience of clinicians working in resource-limited settings. The book includes an overview chapter outlining the current challenges and future directions of sepsis management as well as general recommendations on the structure and organization of intensive care services in resource-limited settings. Specific recommendations on the recognition and management of patients with sepsis and septic shock in these settings are grouped into seven chapters. The book provides evidence-based practical guidance for doctors in low and middle income countries treating patients with sepsis, and highlights areas for further research and discussion.

This book is designed to offer the reader first-rate guidance on shock management in the real world. Comprehensive, evidence-based, and up-to-date instruction is provided on optimal care of patients with different types of shock – septic, hemorrhagic, cardiogenic, anaphylactic, and obstructive – at all stages from initial response through to ICU admission. As well as management, the coverage encompasses pathophysiology, clinical presentation, diagnosis, and emerging trends. A further key feature is the use of a scenario-based approach to present a series of cases based on real-life experiences. Here, a narrative style and Q&A form are employed to vividly convey scenarios that may be encountered in clinical practice and to elucidate decision making in complex circumstances. When readers experience difficulty in answering the questions, the earlier sections can be consulted to identify the correct response. This book will be of great value for all health care professionals. In particular, it will be very helpful for novice or inexperienced practitioners in emergency medicine, critical care medicine, and traumatology.

This book, part of the European Society of Intensive Care Medicine textbook series, teaches readers how to use hemodynamic monitoring, an essential skill for today’s intensivists. It offers a valuable guide for beginners, as well as for experienced intensivists who want to hone their skills, helping both groups detect an inadequacy of perfusion and make the right choices to achieve the main goal of hemodynamic monitoring in the critically ill, i.e., to correctly assess the cardiovascular system and its response to tissue oxygen demands. The book is divided into distinguished sections: from physiology to pathophysiology; clinical assessment and measurements; and clinical practice achievements including techniques, the basic goals in clinical practice as well as the more appropriate hemodynamic therapy to be applied in different conditions. All chapters use a learning-oriented style, with practical examples, key points and take home messages, helping readers quickly absorb the content and, at the same time, apply what they have learned in the clinical setting. The European Society of Intensive Care Medicine has developed the Lessons from the ICU series with the vision of providing focused and state-of-the-art overviews of central topics in Intensive Care and optimal resources for clinicians working in Intensive Care.

This book is designed to provide a comprehensive and state-of-the-art resource for clinicians who care for patients with sepsis and research scientist alike, . Patients with severe sepsis requiring ICU admission have very high rates of ICU and overall hospital mortality, with estimates ranging from 18 to 50%. Risk factors for death from sepsis include underlying illness, increased age, and multi-system organ failure. This is compounded by the significant variation in the management of early severe sepsis. Care of these patients and clinical conditions can be quite complex, and materials are collected from the most current, evidence-based resources. Book sections have been structured to review the overall definitions and epidemiology of sepsis as well as current insights into the pathophysiology of sepsis. This review summarizes the evidence for the international consensus guidelines for the identification and management of sepsis. The latter part of this book reviews emerging concepts and approaches in the diagnosis and management of sepsis that may significantly reduce mortality in the future. Sepsis: Pathophysiology, Definitions and the Challenge of Bedside Management represents a collaboration between authors drawn from a variety of disciplines and contributions from basic scientists and highly recognized clinical opinion leaders with expertise in clinical trials.​

This book represents a collection of paper from different specialists involved in the management of septic patients, aimed to disseminate the knowledge in the field of sepsis, particularly to non-intensivists physicians.

This practically oriented book provides an up-to-date overview of all significant aspects of the pathogenesis of sepsis and its management, including within the intensive care unit. Readers will find information on the involvement of the coagulation and endocrine systems during sepsis and on the use of biomarkers to diagnose sepsis and allow early intervention. International clinical practice guidelines for the management of sepsis are presented, and individual chapters focus on aspects such as fluid resuscitation, vasopressor therapy, response to multiorgan failure, antimicrobial therapy, and adjunctive immunotherapy. The closing section looks forward to the coming decade, discussing novel trial designs, sepsis in low- and middle-income countries, and emerging management approaches. The book is internatio nal in scope, with contributions from leading experts worldwide. It will be of value to residents and professionals/practitioners in the fields of infectious diseases and internal medicine, as well as to GPs and medical students.