SEPSIS MANAGEMENT: DIAGNOSIS AND TREATMENT BASED ON UPDATED GUIDELINES

Abstract

Sepsis is a complex clinical condition, characterized by potentially fatal organic dysfunction, due to an immune response unregulated to the infection. Recognized as one of the main causes of hospital morbidity and mortality, sepsis has high prevalence and significant impact on health systems. The pathophysiology of the syndrome involves an exacerbated inflammatory response, mediated by molecular patterns associated with pathogens (PAMPS) and innate immunological receptors such as Toll-like receptors (TLRS). This initial interaction triggers a systemic inflammatory cascade, with release of proinflammatory cytokines (IL-1, IL-6 and TNF-α), endothelial dysfunction and tissue hypoperfusion, culminating in complications such as septic shock and multiple organ failure. Sepsis management is based on early diagnosis and immediate intervention, as advocated by international guidelines such as Surviving Sepsis Campaign. Tools such as Sofa and Qsofa scores play complementary roles in identifying and stratification of risk in different clinical scenarios. The widely validated sofa score evaluates the dysfunction of six main organic systems, allowing to monitor the progression of the disease. In turn, the simplified application is useful in low complexity environments, although it has limited sensitivity to early detection of the sepsis. Initial interventions include aggressive volume resuscitation, with administration of initial volume crystalloids of 30 ml/kg, and the early onset of broad spectrum antimicrobials, ideally within the first hours after diagnosis. Collection of microbiological cultures before antibiotic therapy is essential to guide therapeutic adjustment. In cases of persistent hypotension, the use of vasopressors, such as norepinephrine, is indicated to restore tissue perfusion and stabilize hemodynamic parameters. Treatment is dynamic and requires continuous monitoring of clinical and laboratory parameters such as serum lactate and average blood pressure. Additional measures include control of the infectious source, management of complications such as hyperglycemia and organic dysfunction, and supporting interventions, such as careful use of corticosteroids in cases of refractory shock. The implementation of evidence -based protocols and the personalized adjustment of interventions is fundamental to optimizing prognosis and reducing sepsis -associated mortality.