Sepsis

Sepsis is an acute, life-threatening syndrome characterized by organ dysfunction resulting from a dysregulated host response to infection. It represents a medical emergency with high in-hospital mortality, particularly when diagnosis and treatment are delayed. The pathophysiology involves simultaneous hyperinflammation (cytokine storm) and immunosuppression, leading to endothelial injury, capillary leak, microvascular thrombosis, and impaired tissue perfusion.

Clinically, sepsis presents with fever or hypothermia, tachycardia (>90 bpm), tachypnea (>20/min), hypotension (SBP <100 mmHg), altered mental status, oliguria, and elevated lactate (>2 mmol/L). Diagnosis follows the Sepsis-3 criteria: suspected or confirmed infection plus an increase in SOFA score ?2 points, indicating organ dysfunction.

Management hinges on the "golden hour" principles: rapid recognition, early broad-spectrum antibiotics (within 1 hour), aggressive IV crystalloid resuscitation (?30 mL/kg in first 3 hours for hypoperfusion), vasopressors for refractory hypotension (target MAP ?65 mmHg), and definitive source control (drainage, debridement, or device removal). Supportive care includes mechanical ventilation for respiratory failure, renal replacement therapy for AKI, and monitoring for complications like DIC and ARDS.

Despite advances in critical care and the 2026 Surviving Sepsis Campaign guidelines, sepsis remains a leading cause of ICU mortality worldwide, underscoring the importance of structured early-warning systems, bundle-based protocols, and post-sepsis follow-up for survivors.