The Surviving Sepsis Campaign Guidelines recommend [11] that a dobutamine infusion should be administered in the event of myocardial dysfunction as indicated by elevated cardiac filling pressures and low cardiac output or ongoing signs of hypoperfusion, despite achieving adequate intravascular volume and adequate MAP. Acute kidney injury in surgical sepsis In patients with surgical sepsis, particular attention should always be paid to acute kidney injury (AKI). A prospective observational institutional study recently published, has shown

that AKI frequently complicates surgical sepsis, and serves as a powerful predictor of hospital mortality in severe sepsis and septic shock. During the 36-month study period ending on December 2010, 246 patients treated for surgical sepsis were evaluated in the study. Tucidinostat cost AKI occurred in 67% of all patients, and 59%, 60%, and 88% of patients had sepsis, surgical sepsis, and septic shock, respectively. Patients with AKI had fewer ventilator-free and intensive care unit selleck free days and a decreased likelihood of discharge to home. Morbidity and mortality increased with severity of AKI, and AKI of any severity was found to be a strong predictor of hospital mortality (odds ratio, 10.59; 95% confidence interval, 1.28Y87.35; p = 0.03) in surgical sepsis [81]. Source control Initial operation The

timing and adequacy of source control are of outmost importance in the management of intra-abdominal sepsis, as late and/or incomplete procedures may have severely adverse consequences on outcome. Source control encompasses all measures undertaken to eliminate the source of infection, reduce the bacterial inoculum and correct or control anatomic derangements to restore normal physiologic function [82, 83]. This generally involves drainage

Mephenoxalone of abscesses or infected fluid collections, debridement of necrotic or infected tissues and definitive control of the source of contamination. It is well known that inadequate source control at the time of the initial operation has been associated with increased mortality in patients with severe intra-abdominal infections [84]. Early control of the septic source can be achieved using both operative and non-operative techniques. An operative intervention remains the most viable therapeutic strategy for managing intra-abdominal sepsis in critical ill patients. The initial aim of the surgical treatment of peritonitis is the elimination of bacterial contamination and inflammatory substances and prevention or reduction, if possible, of fibrin formation. Generally, the surgical source control employed depends on the anatomical source of infection, the Selleck PHA-848125 degree of peritoneal inflammation and generalized septic response, and the patient’s pre-morbid condition. Surgical source control entails resection or suture of a diseased or perforated viscus (e.g. diverticular perforation, gastroduodenal perforation), removal of the infected organ (e.g.