[Frontiers in Bioscience E2, 906-911, June 1, 2010]

Spectrum of sepsis, mediators, source control and management of bundles

Antonino Gullo1, Alice Foti1, Paolo Murabito1, Giovanni Li Volti2, Marinella Astuto1, Carmela Stissi1, Francesca Rubulotta1, Filippo Sanfilippo1, Cristina Santonocito1, Gabriele Sganga3, Giuseppe Ristagno4

1Department and School of Anesthesia and Intensive Care, Catania University-Hospital, Via S. Sofia, 78 95125 Catania, Italy, 2Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, Via Andrea Doria, 6 95125 Catania, Italy, 3Department of Surgery and Transplantation Catholic University, Via Regina Elena 8, Roma, Italy 4Weil Institute of Critical Care Medicine, 35100 Bob Hope DR, Rancho Mirage, California 92270, USA


1. Abstract
2. Introduction
3. Failure of sepsis trials and mediators
4. Importance of the surviving Sepsis campaign
5. Source Control
5.1. Case report
6. Surgical strategy
7. Resuscitation and management bundles
8. Recommendations and conclusion
9. References


Sepsis is a modern medicine icon and the onset of organ dysfunction is one of the worst scenario. More than 100 distinct molecules have been proposed as useful biological markers of sepsis. TNF-alpha, IL-6, chemokines and cytokines are considered the first line factors able to drive the dynamic process of sepsis. The PIRO scheme is a new classification of different aspects, used to stage sepsis. Resuscitation bundles must be started within 6 hours of presentation (serum lactate measured; blood cultures obtained before antibiotic therapy; broad-spectrum antibiotics within 3 hours from emergency admission and 1 hour from ICU admission; in case of hypotension and/or lactate higher than 4 mmol/L deliver an initial 20 ml/kg of crystalloid or colloid solution or apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure above 65 mmHg). A management bundle should be implemented within 24 hour (low-dose steroids administered for septic shock; recombinant human activated protein C; glucose control maintained at less than 8.3 mmol/L; inspiratory plateau pressures maintained at less than 30 cm H2O).