Updates and Controversies in the Early Management of Sepsis and Septic Shock + EMplify podcast audio discussion
Table of Contents

<< Current Topics in Shock and Sepsis Management: Traumatic Hemorrhagic Shock and Septic Shock, Table of Contents

Module 2: Updates and Controversies in the Early Management of Sepsis and Septic Shock + EMplify podcast audio discussion

For patients in the ED who are suspected of having sepsis, swift, effective management is vital to improving outcomes. This issue reviews the latest evidence on the diagnosis and treatment of sepsis and septic shock:

How do the definitions of sepsis affect treatment decisions – and CMS quality measurements?

Is SOFA scoring in the ED possible? Is quickSOFA scoring helpful?

How can you identify the origin of the infection?

What are the lactate clearance, ScvO2, and mean arterial pressure values that you must measure and monitor?

What methods of fluid assessment should be used?

Which vasopressor is the first-line choice? Antibiotics?

Is there a role for imaging in sepsis?

Who needs to go to the ICU and who can be discharged?

Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Definitions and Terminology
  5. Critical Appraisal of the Literature
  6. Epidemiology
  7. Etiology and Pathophysiology
  8. Differential Diagnosis
  9. Prehospital Care
  10. Emergency Department Evaluation
    1. History
    2. Physical Examination
  11. Diagnostic Studies
    1. Laboratory Testing
    2. Lactate Versus Central Venous Oxygen Saturation
    3. Procalcitonin
    4. Imaging
    5. Scoring Systems
  12. Treatment
    1. Initial Management
    2. COVID-19 Effect on Sepsis Screening and Management
    3. Intravenous Fluids
      1. Fluid Volume and Timing
      2. Fluid Type
      3. Fluid Status Assessment
    4. Antibiotics
      1. Antibiotic Timing
      2. Antibiotic Coverage
    5. Vasopressors and Inotropes
      1. Norepinephrine Versus Dopamine
      2. Vasopressin
      3. Epinephrine
      4. Phenylephrine
      5. Vasopressor Timing
        • Angiotensin II
    6. Corticosteroids
    7. Blood Transfusion
  13. Special Populations
    1. Pregnant Patients
    2. Patients With End-Stage Renal Disease
  14. Controversies and Cutting Edge
    1. Controversies
      1. Hour-1 Bundle
      2. Fluid Volume
      3. Etomidate
      4. Vitamin C
    2. Cutting Edge
  15. Disposition
    1. End-of-Life Care
  16. Summary
  17. Risk Management Pitfalls for Sepsis Management in the Emergency Department
  18. Time- and Cost-Effective Strategies
  19. Case Conclusions
  20. Clinical Pathways
    1. Clinical Pathway for Sepsis Screening in the Emergency Department
    2. Clinical Pathway for Initial Management of Patients With Sepsis
  21. Tables
    1. Table 1. Sequential Organ Failure Assessment Score
    2. Table 2. Definitions of Sepsis, Severe Sepsis, and Septic Shock
    3. Table 3. Noninfectious Conditions That May Mimic Sepsis
    4. Table 4. Potential Sources of Infection Associated With Sepsis, by Organ System
    5. Table 5. Historical and Physical Examination Findings Concerning for Sepsis
    6. Table 6. Antibiotic Recommendations by Source of Infection
  22. References


Sepsis is a common and life-threatening condition that requires early recognition and swift initial management. Diagnosis and treatment of sepsis and septic shock are fundamental for emergency clinicians, and include knowledge of clinical and laboratory indicators of subtle and overt organ dysfunction, infection source control, and protocols for prompt identification of the early signs of septic shock. This issue is a structured review of the literature on the management of sepsis, focusing on the current evidence, guidelines, and protocols.

Case Presentations

A 65-year-old man with COPD and diabetes presents from home with a productive cough (green sputum) for 1 week, dyspnea on exertion, and fever. Albuterol at home provided no relief. His vital signs are as follows: heart rate, 102 beats/min; respiratory rate, 22 breaths/min; blood pressure, 130/89 mm Hg, and SpO2, 94% on room air. He is speaking in full sentences and does not appear to be in respiratory distress. He has rales at the right lung base, mild wheezes, and tachycardia. Chest radiograph confirms right lower lobe pneumonia. The patient has no recent hospitalizations. You believe that he looks clinically well and may be able to be discharged home with antibiotics, but you are also concerned for sepsis and wonder if this would be a wise decision...

A 45-year-old man with hypertension and prostate cancer in remission presents complaining of 3 days of burning with urination, fevers, and chills. His vital signs are as follows: heart rate, 110 beats/min; respiratory rate, 20 breaths/ min; blood pressure, 130/90 mm Hg; SpO2, 98% on room air; and temperature, 38.4°C (101.2°F). He is alert and fully oriented. His physical exam reveals mild suprapubic tenderness without rebound or guarding and bilateral costovertebral angle tenderness. Lab findings include a WBC count of 18,000 with 5% bands, a creatinine of 1.5 mg/dL, a platelet count of 130 x 103/mm3, 80 WBCs on urinalysis with positive nitrite and leukocyte esterase, and a serum lactate of 1.2 mmol/L. After receiving ibuprofen and a fluid bolus, the patient feels better and states, “I need to go get my dog!” The nurse asks you if she can remove the IV for the patient to be discharged, which sounds reasonable, but something worries you...

A 70-year-old woman with diabetes mellitus, hypertension, and colon cancer arrives via EMS from a local nursing home for right foot swelling and redness. Paramedics report 2 days of increasing confusion. Her initial blood pressure was 85/50 mm Hg, with a heart rate of 90 beats/min. Her initial glucose was 270 mg/dL. The patient is alert but unable to provide a history. During transfer into her bed, the patient screams in pain as her right leg bumps the bed rail. Your focused exam reveals tachycardia, clear breath sounds, and no acute distress. Her right foot and leg are extremely tender, warm, and erythematous. She has crepitus over the dorsum of the foot and right calf tenderness, but no pretibial edema. The nurse rechecks her vital signs, revealing a blood pressure of 70/40 mm Hg. You order and initiate a fluid bolus. You consider the best antibiotic(s) to start and whether you should initiate pressors before she has received a 30 mL/kg fluid challenge...


Sepsis is triggered by a systemic infection and is a life-threatening, dysregulated response to infection.1 Immune abnormalities induced by invading pathogens or tissue damage produce both the inflammatory and immunosuppressive features of the disease, which causes organ dysfunction and can lead to death. Sepsis may lead to cellular abnormalities and perfusion deficits, causing septic shock. Optimal management strategies for sepsis have been an issue of intense research since a land-mark study by Rivers and colleagues published in 2001 identified a 16% mortality reduction with randomization to an early aggressive care bundle termed early goal-directed therapy (EGDT). EGDT involves the administration of fluids, inotropes, and blood, and the achievement of hemodynamic goals to improve tissue oxygenation, as indicated by a central venous oxygen saturation (ScvO2) >70%.2 After 3 recent multicenter trials failed to validate the results of that study, however, EGDT is no longer recommended.3-5 Nonetheless, in general, early, aggressive management of sepsis is recommended and has been shown to improve outcomes.6-9

This issue of Emergency Medicine Practice reviews the recent changes in sepsis criteria, prognosticators, and quality metrics and offers recommendations on the recognition and treatment of sepsis, severe sepsis, and septic shock in the emergency department.


  1. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801. (Policy)
  2. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377. (Randomized clinical trial; 263 patients)
  3. Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301-1311. (Randomized trial; 1260 patients)
  4. Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683-1693. (Randomized clinical trial; 1341 patients)
  5. Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371(16):1496-1506. (Randomized clinical trial; 1600 patients)
  6. Sterling SA, Puskarich MA, Summers RL, et al. The effect of early quantitative resuscitation on organ function in survivors of septic shock. J Crit Care. 2015;30(2):261-263.  (Prospective observational; 301 patients)
  7. Jones AE, Shapiro NI, Roshon M. Implementing early goal-directed therapy in the emergency setting: the challenges and experiences of translating research innovations into clinical reality in academic and community settings. Acad Emerg Med. 2007;14(11):1072-1078. (Literature review)
  8. Jones AE, Brown MD, Trzeciak S, et al. The effect of a quantitative resuscitation strategy on mortality in patients with sepsis: a meta-analysis. Crit Care Med. 2008;36(10):2734- 2739. (Meta-analysis; 1001 patients)
  9. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign. Crit Care Med. 2017;45(3):486-552. (Policy)
  10. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644-1655. (Guidelines)
  11. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31(4):1250-1256. (Policy)
    11a. Yealy DM, Mohr NM, Shapiro NI, et al. Early care of adults with suspected sepsis in the emergency department and out-of-hospital environment: a consensus-based task force report. Ann Emerg Med. 2021;S0196- 0644(21)00117-7. Online ahead of print. DOI: 10.1016/j.annemergmed.2021.02.006
  12. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315 (8):762-774. (Retrospective; 706,399 patients)
  13. Jouffroy R, Saade A, Carpentier A, et al. Triage of septic patients using qSOFA criteria at the SAMU regulation: a retrospective analysis. Prehosp Emerg Care. 2017;22(1):84-90.  (Retrospective; 141 patients)
  14. Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290. (Retrospective; 184,875 patients)
  15. Hwang SY, Jo IJ, Lee SU, et al. Low accuracy of positive qSOFA criteria for predicting 28-day mortality in critically ill septic patients during the early period after emergency department presentation. Ann Emerg Med. 2017;71(1):1-9. (Retrospective; 1395 patients)
  16. Henning DJ, Puskarich MA, Self WH, et al. An emergency department validation of the SEP-3 sepsis and septic shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017;70(4):544-552. (Prospective observational; 7637 patients)
  17. Haydar S, Spanier M, Weems P, et al. Comparison of qSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis. Am J Emerg Med. 2017;35(11):1730-1733.  (Retrospective; 199 patients)
  18. Umemura Y, Ogura H, Gando S, et al. Assessment of mortality by qSOFA in patients with sepsis outside ICU: a post hoc subgroup analysis by the Japanese Association for Acute Medicine Sepsis Registry Study Group. J Infect Chemother. 2017;23(11):757-762. (Retrospective; 387 patients)
  19. de Groot B, Stolwijk F, Warmerdam M, et al. The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study. Scand J Trauma Resusc Emerg Med. 2017;25(1):91. (Observational; 783 patients)
  20. Churpek MM, Snyder A, Han X, et al. qSOFA, SIRS, and early warning scores for detecting clinical deterioration in infected patients outside the ICU. Am J Respir Crit Care Med. 2017;195(7):906- 911. (Observational; 30,677 patients)
  21. González del Castillo J, Julian-Jiménez A, González-Martínez F, et al. Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department. Eur J Clin Microbiol Infect Dis. 2017;36(12):2361-2369. (Prospective observational; 1071 patients)
  22. Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. 2017;317(3):301. (Prospective observational; 879 patients)
  23. Donnelly JP, Safford MM, Shapiro NI, et al. Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) classification: a retrospective population-based cohort study. Lancet Infect Dis. 2017;17(6):661-670. (Retrospective; 30,239 patients)
  24. Park HK, Kim WY, Kim MC, et al. Quick sequential organ failure assessment compared to systemic inflammatory response syndrome for predicting sepsis in emergency department. J Crit Care. 2017;42:12-17. (Retrospective; 1009 patients)
  25. Dellinger RP. The future of sepsis performance improvement. Crit Care Med. 2015;43(9):1787-1789. (Review)
  26. Faust JS, Weingart SD. The past, present, and future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1. Emerg Med Clin North Am. 2017;35(1):219-231. (Review)
  27. Wang HE, Jones AR, Donnelly JP. Revised national estimates of emergency department visits for sepsis in the United States. Crit Care Med. 2017;45(9):1443-1449. (Cross-sectional; 847,868 patients)
  28. Adhikari NKJ, Fowler RA, Bhagwanjee S, et al. Critical care and the global burden of critical illness in adults. The Lancet. 2010;376(9749):1339-1346. (Review)
  29. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303- 1310. (Retrospective; 192,980 patients)
  30. Mayr FB, Talisa VB, Balakumar V, et al. Proportion and cost of unplanned 30-day readmissions after sepsis compared with other medical conditions. JAMA. 2017;317(5):530.  (Retrospective; 1,187,697 patients)
  31. Chang DW, Tseng C-H, Shapiro MF. Rehospitalizations following sepsis: common and costly. Crit Care Med. 2015;43(10):2085-2093. (Retrospective; 240,198 patients)
  32. Sterling SA, Puskarich MA, Glass AF, et al. The impact of the Sepsis-3 septic shock definition on previously defined septic shock patients. Crit Care Med. 2017;45(9):1436-1442.  (Retrospective; 470 patients)
  33. Driessen RGH, van de Poll MCG, Mol MF, et al. The influence of a change in septic shock definitions on intensive care epidemiology and outcome: comparison of Sepsis-2 and Sepsis-3 definitions. Infect Dis. 2018;50(3):207-213. (Prospective observational; 632 patients)
  34. Buchman TG, Simpson SQ, Sciarretta KL, et al. Sepsis among medicare beneficiaries: 1. The burdens of sepsis, 2012-2018. Crit Care Med. 2020;48(3):276-288. (Claims analysis)
  35. Mira JC, Gentile LF, Mathias BJ, et al. Sepsis pathophysiology, chronic critical illness, and persistent inflammation-immunosuppression and catabolism syndrome. Crit Care Med. 2017;47(2):253- 262. (Review)
  36. Gentile LF, Cuenca AG, Efron PA, et al. Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. J Trauma Acute Care Surg. 2012;72(6):1491- 1501. (Review)
  37. Mathias B, Delmas AL, Ozrazgat-Baslanti T, et al. Human myeloid-derived suppressor cells are associated with chronic immune suppression after severe sepsis/septic shock. Ann Surg. 2017;265 (4):827-834. (Prospective observational; 67 patients)
  38. Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol. 2013;13(12):862-874. (Review)
  39. Cerra FB. The systemic septic response: multiple systems organ failure. Crit Care Clin. 1985;1(3):591-607. (Review)
  40. Lagu T, Rothberg MB, Shieh M-S, et al. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. 2012;40(3):754-761. (Retrospective)
  41. Ranieri VM, Thompson BT, Barie PS, et al. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012;366(22):2055-2064. (Clinical trial; 1697 patients)
  42. Vincent J-L. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323. (Prospective observational; 14,414 patients)
  43. Opal SM, Garber GE, LaRosa SP, et al. Systemic host responses in severe sepsis analyzed by causative microorganism and treatment effects of drotrecogin alfa (activated). Clin Infect Dis. 2003;37(1):50-58. (Clinical trial; 1690 patients)
  44. Abraham E, Reinhart K, Opal S, et al. Efficacy and safety of tifacogin (recombinant tissue factor pathway inhibitor) in severe sepsis: a randomized controlled trial. JAMA. 2003;290(2):238- 247. (Clinical trial; 1690 patients)
  45. Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546-1554. (Retrospective; 750 million patients)
  46. Takeuchi O, Akira S. Pattern recognition receptors and inflammation. Cell. 2010;140(6):805-820. (Review)
  47. Chan JK, Roth J, Oppenheim JJ, et al. Alarmins: awaiting a clinical response. J Clin Invest. 2012;122(8):2711-2719. (Review)
  48. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840-851. (Review)
  49. Boomer JS, To K, Chang KC, et al. Immunosuppression in patients who die of sepsis and multiple organ failure. JAMA. 2011;306(23):2594-2605. (Retrospective; 89 patients)
  50. Walton AH, Muenzer JT, Rasche D, et al. Reactivation of multiple viruses in patients with sepsis. PLoS One. 2014;9(6):e98819. (Clinical trial; 885 patients)
  51. Cunha BA. Infectious Diseases in Critical Care Medicine. 3rd ed: Informa Healthcare USA; 2010.
  52. Femling J, Weiss S, Hauswald E, et al. EMS patients and walk-in patients presenting with severe sepsis: differences in management and outcome. South Med J. 2014;107(12):751-756.  (Prospective observational; 378 patients)
  53. Polito CC, Isakov A, Yancey AH, et al. Prehospital recognition of severe sepsis: development and validation of a novel EMS screening tool. Am J Emerg Med. 2015;33(9):1119-1125.  (Retrospective cohort; 555 patients)
  54. Herlitz J, Bång A, Wireklint-Sundström B, et al. Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care. Scand J Trauma Resusc Emerg Med. 2012;20 (1):42. (Review)
  55. Seymour CW, Rea TD, Kahn JM, et al. Severe sepsis in pre-hospital emergency care: analysis of incidence, care, and outcome. Am J Respir Crit Care Med. 2012;186(12):1264-1271.  (Retrospective; 13,249 patients)
  56. Casu S, Häske D. Severe sepsis and septic shock in pre-hospital emergency medicine: survey results of medical directors of emergency medical services concerning antibiotics, blood cultures and algorithms. Intern Emerg Med. 2016;11(4):571-576. (Cross-sectional; 78 participants)
  57. Baez AA, Hanudel P, Wilcox SR. The Prehospital Sepsis Project: out-of-hospital physiologic predictors of sepsis outcomes. Prehosp Disaster Med. 2013;28(6):632-635. (Cross- sectional; 63 patients)
  58. Báez AA, Hanudel P, Perez MT, et al. Prehospital Sepsis Project (PSP): knowledge and attitudes of United States advanced out-of-hospital care providers. Prehosp Disaster Med. 2013;28 (2):104-106. (Cross-sectional; 226 participants)
  59. Studnek JR, Artho MR, Garner CL, et al. The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med. 2012;30(1):51-56. (Prospective observational; 311 patients)
  60. Wallgren UM, Castrén M, Svensson AEV, et al. Identification of adult septic patients in the prehospital setting. Eur J Emerg Med. 2014;21(4):260-265. (Cross-sectional; 353 patients)
  61. Seymour CW, Cooke CR, Mikkelsen ME, et al. HHS public access. 2014;14(2):145-152. (Secondary analysis of retrospective study; 52 patients)
  62. Bayer O, Schwarzkopf D, Stumme C, et al. An early warning scoring system to identify septic patients in the prehospital setting: the PRESEP Score. Acad Emerg Med. 2015;22(7):868- 871. (Retrospective; 375 patients)
  63. Guerra WF, Mayfield TR, Meyers MS, et al. Early detection and treatment of patients with severe sepsis by prehospital personnel. J Emerg Med. 2013;44(6):1116-1125. (Prospective cohort; 112 patients)
  64. Band RA, Gaieski DF, Hylton JH, et al. Arriving by emergency medical services improves time to treatment endpoints for patients with severe sepsis or septic shock. Acad Emerg Med. 2011;18 (9):934-940. (Prospective observational; 963 patients)
  65. Uittenbogaard AJM, de Deckere ERJT, Sandel MH, et al. Impact of the diagnostic process on the accuracy of source identification and time to antibiotics in septic emergency department patients. Eur J Emerg Med. 2014;21(3):212-219. (Secondary analysis of prospective observational; 323 patients)
  66. Hollemans RA, van Brunschot S, Bakker OJ, et al. Minimally invasive intervention for infected necrosis in acute pancreatitis. Expert Rev Med Devices. 2014;11(6):637-648. (Review)
  67. Tong Z, Shen X, Ke L, et al. The effect of a novel minimally invasive strategy for infected necrotizing pancreatitis. Surg Endosc. 2017;31(11):4603-4616. (Clinical trial; 229 patients)
  68. Hosek WT, Laeger TC. Early diagnosis of necrotizing fasciitis with soft tissue ultrasound. Acad Emerg Med. 2009;16(10):1033. (Case report; 1 patient)
  69. Cortellaro F, Ferrari L, Molteni F, et al. Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study. Intern Emerg Med. 2017;12(3):371- 378. (Clinical trial; 200 patients)
  70. Vincent J-L, De Backer D. Circulatory shock. N Engl J Med. 2013;369(18):1726-1734. (Review)
  71. Pandharipande PP, Shintani AK, Hagerman HE, et al. Derivation and validation of Spo2/Fio2 ratio to impute for Pao2/Fio2 ratio in the respiratory component of the sequential organ failure assessment score. Crit Care Med. 2009;37(4):1317-1321. (Prospective observational; 2986 patients)
  72. Grissom CK, Brown SM, Kuttler KG, et al. A modified sequential organ failure assessment score for critical care triage. Disaster Med Public Health Prep. 2010;4(4):277-284.  (Prospective observational; 1770 patients)
  73. Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Critical Care. 2014;18(5):503. (Review)
  74. Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739- 746. (Clinical trial; 300 patients)
  75. Jansen T, van Bommel J, Schoonderbeek F, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182(6):752-761. (Clinical trial; 348 patients)
  76. Tian H-H, Han S-S, Lv C-J, et al. [The effect of early goal lactate clearance rate on the outcome of septic shock patients with severe pneumonia]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012;24(1):42-45. (Clinical trial; 62 patients)
  77. Yu B, Tian H-Y, Hu Z-J, et al. [Comparison of the effect of fluid resuscitation as guided either by lactate clearance rate or by central venous oxygen saturation in patients with sepsis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013;25(10):578-583. (Clinical trial; 50 patients)
  78. Lyu X, Xu Q, Cai G, et al. [Efficacies of fluid resuscitation as guided by lactate clearance rate and central venous oxygen saturation in patients with septic shock]. Zhonghua Yi Xue Za Zhi. 2015;95(7):496-500. (Clinical trial; 100 patients)
  79. Zhou X, Liu D, Su L, et al. Use of stepwise lactate kinetics-oriented hemodynamic therapy could improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. Crit Care. 2017;21(1):33. (Clinical trial; 360 patients)
  80. Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019;321(7):654-664. (Multicenter, randomized trial; 424 patients)
  81. Schuetz P, Müller B, Christ-Crain M, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2012;9:CD007498. (Review)
  82. Matthaiou DK, Ntani G, Kontogiorgi M, et al. An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients. Intensive Care Med. 2012;38(6):940-949. (Meta-analysis)
  83. Fischer JE, Harbarth S, Agthe AG, et al. Quantifying uncertainty: physicians' estimates of infection in critically ill neonates and children. Clin Infect Dis. 2004;38(10):1383- 1390. (Prospective observational; 347 patients)
  84. Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302(10):1059-1066. (Clinical trial; 1359 patients)
  85. Schuetz P, Kutz A, Grolimund E, et al. Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms: results from the randomized ProHOSP trial. Int J Cardiol. 2014;175(3):464-472. (Clinical trial; 233 patients)
  86. Soni NJ, Samson DJ, Galaydick JL, et al. Procalcitonin-guided antibiotic therapy: A systematic review and meta-analysis. J Hosp Med. 2013;8(9):530-540. (Meta-analysis)
  87. Schuetz P, Briel M, Christ-Crain M, et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis. 2012;55(5):651-662. (Meta-analysis; 4221 patients)
  88. Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017;10:CD007498.  (Review)
  89. Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(5):426-435. (Meta- analysis; 3244 patients)
  90. Westwood M, Ramaekers B, Whiting P, et al. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2015;19(96):1-236. (Meta-analysis)
  91. Just KS, Defosse JM, Grensemann J, et al. Computed tomography for the identification of a potential infectious source in critically ill surgical patients. J Crit Care. 2015;30(2):386- 389. (Retrospective; 76 patients)
  92. Kaukonen K, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372(17):1-10. (Retrospective study; 1,171,797 patients)
  93. Guirgis FW, Jones L, Esma R, et al. Managing sepsis: electronic recognition, rapid response teams, and standardized care save lives. J Crit Care. 2017;40:296-302. (Retrospective review; 3917 patients)
  94. Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020;48(6):e440-e469. (Guidelines)
  95. Leisman DE, Goldman C, Doerfler ME, et al. Patterns and outcomes associated with timeliness of initial crystalloid resuscitation in a prospective sepsis and septic shock cohort. Crit Care Med. 2017;45(10):1596-1606. (Prospective observational; 11,182 patients)
  96. Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376(23):2235-2244. (Retrospective; 49,331 patients)
  97. Taylor SP, Karvetski CH, Templin MA, et al. Initial fluid resuscitation following adjusted body weight dosing is associated with improved mortality in obese patients with suspected septic shock. J Crit Care. 2018;43:7-12. (Retrospective multicenter study; 4157 patients)
  98. Self WH, Semler MW, Wanderer JP, et al. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med. 2018;378(9):819-828. (Single-center, pragmatic, multiple- crossover trial; 13,347 patients)
  99. Semler MW, Self WH, Wanderer JP, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;378(9):829-839. (Pragmatic cluster-randomized multiple- crossover trial; 15,802 patients)
  100. Hjortrup PB, Haase N, Bundgaard H, et al. Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med. 2016;42(11):1695-1705. (Clinical trial; 151 patients)
  101. Shujaat A, Bajwa A. Optimization of preload in severe sepsis and septic shock. Crit Care Res Pract. 2012;2012:761051. (Review)
  102. Moretti R, Pizzi B. Inferior vena cava distensibility as a predictor of fluid responsiveness in patients with subarachnoid hemorrhage. Neurocrit Care. 2010;13(1):3-9. (Clinical trial; 29 patients)
  103. Kanji HD, McCallum J, Sirounis D, et al. Limited echocardiography–guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care. 2014;29 (5):700-705. (Clinical trial; 220 patients)
  104. Preau S, Bortolotti P, Colling D, et al. Diagnostic accuracy of the inferior vena cava collapsibility to predict fluid responsiveness in spontaneously breathing patients with sepsis and acute circulatory failure. Crit Care Med. 2017;45(3):e290-e297. (Prospective; 90 patients)
  105. Zhang Z, Xu X, Ye S, et al. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients: systematic review and meta- analysis. Ultrasound Med Biol. 2014;40(5):845-853. (Systematic review)
  106. Via G, Tavazzi G, Price S. Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view. Intensive Care Med. 2016;42(7):1164-1167.
  107. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013;41(7):1774- 1781. (Meta-analysis)
  108. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34 (6):1589-1596. (Retrospective; 2154 patients)
  109. Puskarich MA, Trzeciak S, Shapiro NI, et al. Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Crit Care Med. 2011;39(9):2066-2071. (Clinical trial; 291 patients)
  110. Liu VX, Fielding-Singh V, Greene JD, et al. The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med. 2017;196(7):856-863. (Retrospective; 35,000 patients)
  111. de Groot B, Ansems A, Gerling DH, et al. The association between time to antibiotics and relevant clinical outcomes in emergency department patients with various stages of sepsis: a prospective multi-center study. Crit Care. 2015;19(1):194. (Prospective multicenter study; 1168 patients)
  112. Ryoo SM, Kim WY, Sohn CH, et al. Prognostic value of timing of antibiotic administration in patients with septic shock treated with early quantitative resuscitation. Am J Med Sci. 2015;349 (4):328-333. (Prospective; 426 patients)
  113. Sterling SA, Miller WR, Pryor J, et al. The impact of timing of antibiotics on outcomes in severe sepsis and septic shock: a systematic review and meta-analysis. Crit Care Med. 2015;43(9):1907 -1915. (Systematic review and meta-analysis)
  114. Kumar A, Ellis P, Arabi Y, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136(5):1237- 1248. (Retrospective; 5715 patients)
  115. Ibrahim EH, Sherman G, Ward S, et al. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118(1):146- 155. (Prospective observational; 492 patients)
  116. Paul M, Shani V, Muchtar E, et al. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother. 2010;54(11):4851- 4863. (Meta-analysis; 21,338 patients)
  117. Micek ST, Welch EC, Khan J, et al. Empiric combination antibiotic therapy is associated with improved outcome against sepsis due to gram-negative bacteria: a retrospective analysis. Antimicrob Agents Chemother. 2010;54(5):1742-1748. (Retrospective; 760 patients)
  118. Arancibia F, Bauer TT, Ewig S, et al. Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med. 2002;162(16):1849- 1858. (Retrospective review; 599 patients)
  119. Kumar A, Zarychanski R, Light B, et al. Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis. Crit Care Med. 2010;38(9):1773-1785. (Retrospective; 1223 patients)
  120. Safdar N, Handelsman J, Maki DG. Does combination antimicrobial therapy reduce mortality in gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis. 2004;4(8):519-527.  (Meta-analysis; 3077 patients)
  121. Paul M, Soares-Weiser K, Leibovici L. Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta- analysis. BMJ. 2003;326(7399):1111. (Meta-analysis; 7087 patients)
  122. Kuster SP, Rudnick W, Shigayeva A, et al. Previous antibiotic exposure and antimicrobial resistance in invasive pneumococcal disease: results from prospective surveillance. Clin Infect Dis. 2014;59(7):944-952. (Prospective observational study; 4062 patients)
  123. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27-S72. (Review)
  124. File TM, Niederman MS. Antimicrobial therapy of community-acquired pneumonia. Infect Dis Clin North Am. 2004;18(4):993-1016. (Review)
  125. Cardenas-Garcia J, Schaub KF, Belchikov YG, et al. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015;10(9):581-585. (Clinical trial; 734 patients)
  126. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-789. (Clinical trial; 1679 patients)
  127. De Backer D, Aldecoa C, Njimi H, et al. Dopamine versus norepinephrine in the treatment of septic shock. Crit Care Med. 2012;40(3):725-730. (Meta-analysis; 2768 patients)
  128. Fawzy A, Evans SR, Walkey AJ. Practice patterns and outcomes associated with choice of initial vasopressor therapy for septic shock. Crit Care Med. 2015;43(10):2141-2146.  (Retrospective; 61,122 patients)
  129. Belletti A, Benedetto U, Biondi-Zoccai G, et al. The effect of vasoactive drugs on mortality in patients with severe sepsis and septic shock. A network meta-analysis of randomized trials. J Crit Care. 2017;37:91-98. (Meta-analysis; 3470 patients)
  130. Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358(9):877-887. (Clinical trial; 778 patients)
  131. Gordon AC, Russell JA, Walley KR, et al. The effects of vasopressin on acute kidney injury in septic shock. Intensive Care Med. 2010;36(1):83-91. (Clinical trial; 778 patients)
  132. Lauzier F, Lévy B, Lamarre P, et al. Vasopressin or norepinephrine in early hyperdynamic septic shock: a randomized clinical trial. Intensive Care Med. 2006;32(11):1782- 1789. (Clinical trial; 23 patients)
  133. Patel BM, Chittock DR, Russell JA, et al. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology. 2002;96(3):576-582. (Clinical trial; 24 patients)
  134. Landry DW, Levin HR, Gallant EM, et al. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation. 1997;95(5):1122-1125. (Clinical trial; 19 patients)
  135. Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. JAMA. 2016;316(5):509. (Clinical trial; 18 patients)
  136. Polito A, Parisini E, Ricci Z, et al. Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis. Intensive Care Med. 2012;38(1):9-19. (Meta- analysis; 1134 patients)
  137. Serpa Neto A, Nassar AP, Cardoso SO, et al. Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials. Crit Care. 2012;16(4):R154. (Meta-analysis; 998 patients)
  138. Myburgh JA, Higgins A, Jovanovska A, et al. A comparison of epinephrine and norepinephrine in critically ill patients. Intensive Care Med. 2008;34(12):2226-2234. (Clinical trial; 280 patients)
  139. Annane D, Vignon P, Renault A, et al. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet (London, England). 2007;370(9588):676- 684. (Clinical trial; 330 patients)
  140. Gregory JS, Bonfiglio MF, Dasta JF, et al. Experience with phenylephrine as a component of the pharmacologic support of septic shock. Crit Care Med. 1991;19(11):1395-1400.  (Retrospective)
  141. Morelli A, Ertmer C, Rehberg S, et al. Phenylephrine versus norepinephrine for initial hemodynamic support of patients with septic shock: a randomized, controlled trial. Critical Care. 2008;12 (6):R143. (Clinical trial; 32 patients)
  142. Jain G, Singh DK. Comparison of phenylephrine and norepinephrine in the management of dopamine-resistant septic shock. Indian J Crit Care Med. 2010;14(1):29. (Clinical trial; 54 patients)
  143. Permpikul C, Tongyoo S, Viarasilpa T, et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). a randomized trial. Am J Respir Crit Care Med. 2019;199(9):1097- 1105. (Single-center, randomized, double-blind, placebo-controlled clinical trial; 310 patients)
  144. Khanna A, English SW, Wang XS, et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017;377(5):419-430. (Clinical trial; 344 patients)
  145. Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862- 871. (Clinical trial; 300 patients)
  146. Bollaert PE, Charpentier C, Levy B, et al. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med. 1998;26(4):645-650. (Clinical trial; 41 patients)
  147. Schelling G, Stoll C, Kapfhammer HP, et al. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med. 1999;27(12):2678-2683. (Retrospective; 54 patients)
  148. Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358(2):111-124. (Clinical trial; 499 patients)
  149. Annane D, Pastores SM, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med. 2017;43(12):1751-1763. (Guidelines/policy)
  150. Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med. 2018;378(9):797-808. (Clinical trial; 3800 patients)
  151. Annane D, Buisson CB, Cariou A, et al. Design and conduct of the activated protein C and corticosteroids for human septic shock (APROCCHSS) trial. Ann Intensive Care. 2016;6 (1):43. (Multicenter randomized placebo-controlled double-blind trial; 1241 patients)
  152. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;41(2):580- 637. (Guidelines/policy)
  153. Holst LB, Haase N, Wetterslev J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med. 2014;371(15):1381-1391. (Clinical trial; 998 patients)
  154. Nachtigall I, Tafelski S, Rothbart A, et al. Gender-related outcome difference is related to course of sepsis on mixed ICUs: a prospective, observational clinical study. Crit Care. 2011;15 (3):R151. (Clinical trial; 709 patients)
  155. da Silva FP, Machado MCC. Septic shock and the aging process: a molecular comparison. Front Immunol. 2017;8:1-7. (Review)
  156. Iwashyna TJ, Cooke CR, Wunsch H, et al. Population burden of long-term survivorship after severe sepsis in older americans. J Am Geriatr Soc. 2012;60(6):1070-1077. (Retrospective observational; 637,867 patients)
  157. Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. 2012;120(3):689-706. (Review)
  158. Kankuri E, Kurki T, Carlson P, et al. Incidence, treatment and outcome of peripartum sepsis. Acta Obstet Gynecol Scand. 2003;82(8):730-735. (Retrospective; 43,483 patients)
  159. Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int. 2000;58(4):1758-1764. (Observational study; 2746 patients)
  160. Rojas L, Muñoz P, Kestler M, et al. Bloodstream infections in patients with kidney disease: risk factors for poor outcome and mortality. J Hosp Infect. 2013;85(3):196-205.  (Retrospective; 108 patients)
  161. de Carvalho MA, Freitas FGR, Silva Jr HT, et al. Mortality predictors in renal transplant recipients with severe sepsis and septic shock. PLoS One. 2014;9(11):e111610.  (Retrospective; 190 patients)
  162. Abou Dagher G, Harmouche E, Jabbour E, et al. Sepsis in hemodialysis patients. BMC Emerg Med. 2015;15:30. (Retrospective; 90 patients)
  163. Otero RM, Nguyen HB, Huang DT, et al. Early goal-directed therapy in severe sepsis and septic shock revisited. Chest. 2006;130(5):1579-1595. (Review)
  164. Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44(6):925-928. (Guidelines update)
  165. Marik PE, Farkas JD, Spiegel R, et al. POINT: Should the Surviving Sepsis Campaign Guidelines Be Retired? Yes. Chest. 2019;155(1):12-14. (Editorial)
  166. Levy MM, Rhodes A, Evans LE. Rebuttal From Drs Levy, Rhodes, and Evans. Chest. 2019;155(1):19-20. (Editorial)
  167. Marik PE, Farkas JD, Spiegel R, et al. Rebuttal From Drs Marik, Farkas, Spiegel et al. Chest. 2019;155(1):17-18. (Editorial)
  168. Levy MM, Rhodes A, Evans LE. COUNTERPOINT: Should the Surviving Sepsis Campaign Guidelines Be Retired? No. Chest. 2019;155(1):14-17. (Editorial)
  169. Kalantari A, Rezaie SR. Challenging the One-hour Sepsis Bundle. West J Emerg Med. 2019;20(2):185-190. (Review)
  170. Van Berkel MA, Exline MC, Cape KM, et al. Increased incidence of clinical hypotension with etomidate compared to ketamine for intubation in septic patients: a propensity matched analysis. J Crit Care. 2017;38:209-214. (Retrospective; 384 patients)
  171. Chan CM, Mitchell AL, Shorr AF. Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis. Crit Care Med. 2012;40(11):2945-2953. (Literature review)
  172. Sterling SA, Puskarich MA, Jones AE. The effect of etomidate on mortality in sepsis remains unclear. Crit Care Med. 2013;41(6):e95. (Meta-analysis)
  173. Marik PE, Khangoora V, Rivera R, et al. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock. Chest. 2017;151(6):1229-1238. (Before-after; 94 patients)
  174. Fujii T, Luethi N, Young PJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020;323(5):423-431. (Multicenter open-label randomized clinical trial; 211 patients)
  175. Fowler AA, 3rd, Truwit JD, Hite RD, et al. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA. 2019;322(13):1261-1270. (Randomized double-blind placebo-controlled multicenter trial; 167 patients)
  176. Chang P, Liao Y, Guan J, et al. Combined Treatment With Hydrocortisone, Vitamin C, and Thiamine for Sepsis and Septic Shock: A Randomized Controlled Trial. Chest. 2020;158(1):174- 182. (Single-blind randomized controlled trial; 80 patients)
  177. Perner A, Gordon AC, Angus DC, et al. The intensive care medicine research agenda on septic shock. Intensive Care Med. 2017;43(9):1294-1305. (Review)
  178. Seymour CW, Kennedy JN, Wang S, et al. Derivation, validation, and pPotential treatment implications of novel clinical phenotypes for sepsis. JAMA. 2019;321(20):2003-2017.  (Retrospective data analysis; 20,189 patients)
  179. Lewis RJ, Viele K, Broglio K, et al. An adaptive, phase II, dose-finding clinical trial design to evaluate L-carnitine in the treatment of septic shock based on efficacy and predictive probability of subsequent phase III success. Crit Care Med. 2013;41(7):1674-1678. (Clinical trial; 250 patients)
  180. Hotchkiss RS, Monneret G, Payen D. Immunosuppression in sepsis: a novel understanding of the disorder and a new therapeutic approach. Lancet Infect Dis. 2013;13(3):260-268.  (Literature review)
  181. Delgado MK, Liu V, Pines JM, et al. Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated healthcare system. J Hosp Med. 2013;8(1):13-19. (Prospective observational; 178,315 patients)
  182. Liu V, Kipnis P, Rizk NW, et al. Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system. J Hosp Med. 2012;7(3):224-230.  (Prospective observational; 6396 patients)
  183. Parkhe M, Myles PS, Leach DS, et al. Outcome of emergency department patients with delayed admission to an intensive care unit. Emerg Med. 2002;14(1):50-57. (Retrospective; 122 patients)
  184. Wardi G, Wali AR, Villar J, et al. Unexpected intensive care transfer of admitted patients with severe sepsis. J Intensive Care. 2017;5(1):43. (Prospective observational; 914 patients)
  185. Capp R, Horton CL, Takhar SS, et al. Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency department arrival. Crit Care Med. 2015;43(5):983-988. (Retrospective observational; 18,100 patients)
  186. Powell ES, Sauser K, Cheema N, et al. Severe sepsis in do-not-resuscitate patients: Intervention and mortality rates. J Emerg Med. 2013;44(4):742-749. (Retrospective; 376 patients)
  187. CM T, BJ M. National inpatient hospital costs: the most expensive conditions by payer, 2013 - Statistical Brief #204. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality (US); 2006-2016.
  188. Jones SL, Ashton CM, Kiehne L, et al. Reductions in sepsis mortality and costs after design and implementation of a nurse-based early recognition and response program. Jt Comm J Qual Patient Saf. 2015;41(11):483-491. (Clinical trial; 9718 patients)

<< Previous | Topic Table of Contents | Next >>