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Insight

Mohammad Vaziri Shares Evidence-Based Review on Sepsis Management

Mohammad Vaziri/LinkedIn

Oct 20, 2025, 13:20

Mohammad Vaziri Shares Evidence-Based Review on Sepsis Management

Mohammad Vaziri, Thoracic Surgery Professional at IRAN University of Medical Sciences (IUMS), posted on LinkedIn:

“All of the following are effective in decreasing mortality in severe sepsis EXCEPT
achieving central venous oxygen saturation of 70% within 6 hours of presentation (early goal-directed therapy)
activated protein C (rhAPC) administration
achieving supranormal oxygen delivery (> 600 mL/min/m2)
intravenous corticosteroids for ACTH nonresponders
tight glucose control (80 to110 mg/dL)

Systemic inflammatory response syndrome (SIRS) is defined as two or more of the following: temperature > 38°C or < 36°C, pulse > 90 beats/min, respiratory rate > 20, or PaCO2 < 32 mm Hg. Sepsis is SIRS in the setting of documented infection, and severe sepsis is sepsis accompanied by organ dysfunction or signs of hypoperfusion (lactic acidosis, oliguria, or altered mental status). When hypotension is also present, the patient is considered to be in septic shock.

Activated protein C (APC) is an endogenous protein that promotes fibrinolysis and inhibits thrombosis and inflammation.

Levels of endogenous protein C are reduced in septic patients. Exogenously administrated APC reduces mortality in patients with severe sepsis and organ failure from 31% to 25%. APC predisposes to severe bleeding, and must be used with caution perioperatively and in patients at risk for bleeding.

Other more generalized approaches to the treatment of severe sepsis are also beneficial. Early goal-directed resuscitation involves aggressive correction of central venous PO2 within the first 6 hours after presentation using protocol-driven administration of intravenous fluids, pressors, and transfusion of blood. In a study of patients with severe sepsis and septic shock, mortality was reduced from 47% to 31%.

Patients with severe sepsis and septic shock shown to have adrenal insufficiency had a reduction in mortality from 63% to 53% when given a regimen of hydrocortisone and fludrocortisone. In patients admitted to a surgical ICU, tight blood glucose control (80 to 120 mg/dL) reduced mortality from 8.0% to 4.6%, mostly due to a reduction in deaths from multiple organ failure with a proven septic focus.

All of these reductions in mortality were statistically significant. Supranormal oxygen delivery (oxygen delivery > 600 mL/min) does not reduce mortality in patients with severe sepsis and organ failure, and may in some cases increase the incidence of abdominal compartment syndrome.”

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activated protein C (rhAPC) Health Hematology Hemostasis Hemostasis Today Medicine Mohammad Vaziri Sepsis Management Systemic inflammatory response syndrome (SIRS)

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