The speed and appropriateness of therapy administered in the initial hours after sepsis develops influences outcome, as is the case for acute myocardial infarction and
Pertinent issues in the management of septic patients are (Fig. 82-1):
1. Early goal-directed resuscitation of septic patients during the first 6 hours after recognition.
2. Early administration of broad-spectrum anti-infective therapy.
3. Activated protein C in patients with severe sepsis and high risk of death (Acute Physiology, Age, and Chronic Health Evaluation II [APACHE II] score greater than 25).
4. Hydrocortisone for septic shock patients refractory to resuscitation and vasopressors.
5. Glycemic control via infusion of insulin and glucose, to maintain a glucose level less than 150 mg/dL (8.3 mmol/L).
6. Adjunctive therapies: nutrition, deep vein thrombosis (DVT) prophylaxis, stress ulcer prophylaxis, and sedation for mechanically ventilated patients.
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