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Key Points

  • Identification of the septic patient is the important first step. All other critical actions are missed if this does not occur.

  • Lactate measurement is critical to determining sepsis severity, response to therapy, and prognosis.

  • Early administration of appropriate antimicrobials and early goal-directed therapy are the mainstays of treatment.

  • Resuscitation of the critically ill septic patient should occur concurrent or before diagnostic evaluation.


Sepsis is now defined as “infection plus systemic manifestations of infection” (Table 34-1). Systemic inflammatory response syndrome is no longer a strict criteria. There are 3 sepsis syndromes (stages): uncomplicated sepsis, severe sepsis, and septic shock. Sepsis becomes severe sepsis when there is tissue hypoperfusion or organ dysfunction (Table 34-2). Septic shock is defined as a systolic blood pressure (SBP) <90 mmHg or 40 mmHg below one's baseline blood pressure, despite two 20- to 30-mL/kg boluses.

Table 34-1.

Diagnostic criteria for sepsis.

Table 34-2.

Diagnostic criteria for severe sepsis.

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