By the end of this chapter you will be able to

• be aware of the terminology used

• understand the underlying pathophysiology of sepsis

• understand the principles of circulatory resuscitation in sepsis

• understand the role of intensive care in supporting patients

• appreciate the effects of sepsis on the lung

• be aware of recent advances in therapy

• know about microbiological considerations

• apply this to your clinical practice

The incidence of sepsis is increasing and is a major cause of morbidity and mortality in hospital. It is the leading cause of death in UK ICUs. The increasing use of immunosuppressant agents, broad-spectrum antibiotics, and invasive technology is contributing to the rising incidence. Around one-third of UK ICU admissions are now due to severe sepsis. In the USA the annual incidence of sepsis is in the order of 400 000 per year with 200 000 cases of septic shock and an estimated 100 000 deaths. In Holland it has been recorded that severe sepsis occurs in 136 per 1000 and septic shock in 46 per 100 hospital admissions. Early recognition and treatment is vital - once organ failure is established, mortality is over 50% (Table 7.1).

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