Can we reduce mortality in sepsis?

Considerable progress has been made over the last 2 decades in diagnosing and treating sepsis. Although the mortality rate is beginning to decline with the development of new therapeutic interventions, it still remains unacceptably high. Five such interventions are discussed in this review article to provide guidance for intensivists on the integration and implementation of new interventions into the intensive care unit. They were shown in randomized, controlled trials to reduce mortality by limiting the tidal volume in acute lung injury or acute respiratory distress syndrome, the early goal directed therapy, the use of recombinant human activated protein C, the use of moderate doses of steroids and the tight control of blood sugar. Each new intervention has a role in the management of sepsis, however they are not mutually exclusive. This article provides guidelines on optimal patient selection and timing for each intervention and provides advice on how to integrate new therapies in intensive care practice so that mortality rates can be reduced.