Beyond the bundle: Clinical controversies in the management of sepsis in emergency medicine patients

• Published in: The American journal of emergency medicine Vol. 51; pp. 296 - 303
• Main Authors: Krishnan, Kavita, Wassermann, Travis B., Tednes, Patrick, Bonderski, Veronica, Rech, Megan A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2022; Elsevier Limited
• Subjects: Adrenergic receptors; Angiotensin; Angiotensin II; Angiotensin II - therapeutic use; Ascorbic acid; Ascorbic Acid - therapeutic use; Clinical trials; Crystalloid Solutions - therapeutic use; Disease Management; Dosage; Drug Therapy, Combination; Emergency medical care; Emergency Service, Hospital; Humans; Hydrocortisone; Hydrocortisone - therapeutic use; Hypotension; Ischemia; Mortality; Obesity; Patients; Randomized Controlled Trials as Topic; Sepsis; Sepsis - drug therapy; Septic shock; Shock, Septic - drug therapy; Simendan - therapeutic use; Smooth muscle; Steroids; Thiamine; Thiamine - therapeutic use; Treatment; Vitamin B; Sepsis; Treatment; Angiotensin II; Hydrocortisone; Thiamine; ED
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2021.11.003

Sepsis is a condition characterized by life-threatening organ dysfunction caused by a dysregulated host response to infection. The emergency department (ED) serves as a crucial entry point for patients presenting with sepsis. Given the heterogeneous presentation and high mortality rate associated with sepsis and septic shock, several clinical controversies have emerged in the management of sepsis. These include the use of novel therapeutic agents like angiotensin II, hydrocortisone, ascorbic acid, thiamine (“HAT”) therapy, and levosimendan, Additionally, controversies with current treatments in vasopressor dosing, and the use of and balanced or unbalanced crystalloid are crucial to consider. The purpose of this review is to discuss clinical controversies in the management of septic patients, including the use of novel medications and dosing strategies, to assist providers in appropriately determining what treatment strategy is best suited for patients.