This article is part of the supplement: Reducing mortality in sepsis: new directions .

Review

Reducing mortality in sepsis: new directions

Jean-Louis Vincent¹ , Edward Abraham², Djillali Annane³, Gordon Bernard⁴, Emanuel Rivers⁵ and Greet Van den Berghe⁶

¹Professor of Intensive Care Medicine, Head, Department of Intensive Care, Erasme Hospital (Free University of Brussels), Brussels, Belgium

²Roger Sherman Mitchell Professor of Pulmonary and Critical Care Medicine, Head, Division of Pulmonary Sciences and Critical Care Medicine, Vice Chair, Administrative Affairs, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA

³Professor in Intensive Care Medicine, Service de Réanimation Médicale, Hôpital Raymond Poincaré, Faculté de Médecine Paris Ile de France Ouest, Université de Versailles, Saint Quentin en Yvelinnes, Garches, France

⁴Professor of Medicine, Director, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

⁵Assistant Professor, Department of Emergency Medicine and Surgery, Director of Research, Department of Emergency Medicine, Senior Staff Attending in Emergency Medicine and Surgical Critical Care, Henry Ford Health Systems, Case Western Reserve University, Detroit, Michigan, USA

⁶Professor, Department of Intensive Care Medicine, University of Leuven, Belgium

author email corresponding author email

Critical Care 2002, 6(Suppl 3):S1-S18doi:10.1186/cc1860

Published:	5 December 2002

Abstract

Considerable progress has been made in the past few years in the development of therapeutic interventions that can reduce mortality in sepsis. However, encouraging physicians to put the results of new studies into practice is not always simple. A roundtable was thus convened to provide guidance for clinicians on the integration and implementation of new interventions into the intensive care unit (ICU). Five topics were selected that have been shown in randomized, controlled trials to reduce mortality: limiting the tidal volume in acute lung injury or acute respiratory distress syndrome, early goal-directed therapy, use of drotrecogin alfa (activated), use of moderate doses of steroids, and tight control of blood sugar. One of the principal investigators for each study was invited to participate in the roundtable. The discussions and questions that followed the presentation of data by each panel member enabled a consensus recommendation to be derived regarding when each intervention should be used. Each new intervention has a place in the management of patients with sepsis. Furthermore, and importantly, the therapies are not mutually exclusive; many patients will need a combination of several approaches – an 'ICU package'. The present article provides guidelines from experts in the field on optimal patient selection and timing for each intervention, and provides advice on how to integrate new therapies into ICU practice, including protocol development, so that mortality rates from this disease process can be reduced.