Chapter 31 - Sepsis

Summary

Sepsis is the leading cause of mortality in the critically ill patient in general, and one of the leading causes of maternal mortality worldwide. It is characterized by a massive inflammatory response leading to hypotension secondary to a decrease in systemic vascular resistance, cardiac dysfunction, activation of the clotting cascade, inhibition of natural anticoagulant pathways, and mitochondrial impairment. Before discussing the management of sepsis, the importance of prevention must be emphasized, as this is probably the one intervention that most affects the incidence of sepsis and its mortality. Prevention includes hygienic measures, antibiotic prophylaxis, selective gastrointestinal decontamination, and optimizing the metabolic and nutritional condition of women. The Surviving Sepsis Campaign highlights the importance of the rapid diagnosis and management of sepsis that is critical to successful treatment. Of pivotal importance in the management of sepsis is to achieve early source control and institute adequate antibiotic therapy.