Sepsis and septic shock

Also known as Sepsis · Septic shock · Sepsis-3 definitions · Surviving Sepsis Campaign · Early goal-directed therapy (EGDT) · qSOFA

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is sepsis with circulatory and cellular/metabolic abnormalities (lactate 2, vasopressor requirement) associated with substantially increased mortality. The Surviving Sepsis Campaign 2021 guidelines provide the evidence-based framework: antibiotics within 1 hour, crystalloid at least 30 mL/kg, noradrenaline for MAP =65, lactate normalisation. The EGDT era (Rivers 2001) was overturned by ProCESS, ARISE, and ProMISe (2014, 2017). Corticosteroids (APROCCHSS 2018) for vasopressor-dependent shock. Mortality over 10% in sepsis and over 40% in septic shock (Sepsis-3).

high26 referencesUpdated 13 Oct 202615 min readSource-verified · Oct 2026

Checked against its sources on 13 Oct 2026

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17 MCQs

In one line

Sepsis = life-threatening organ dysfunction from dysregulated host response to infection (SOFA ≥2, in-hospital mortality above 10%). Septic shock = sepsis with vasopressor requirement for MAP ≥65 AND lactate >2 mmol/L in the absence of hypovolaemia (hospital mortality above 40%). SSC 2021 Hour-1 Bundle: (1) measure lactate, (2) blood cultures before antibiotics (no substantial delay), (3) broad-spectrum antimicrobials immediately, ideally within 1 hour, (4) at least 30 mL/kg crystalloid within the first 3 hours for hypoperfusion or shock, (5) vasopressors if hypotensive during or after fluids, targeting MAP ≥65. Noradrenaline first-line vasopressor. APROCCHSS: hydrocortisone + fludrocortisone lowered 90-day mortality in vasopressor-dependent shock. Do NOT use EGDT (CVP/ScvO2 targets — ProCESS/ARISE/ProMISe showed no benefit).^[1]^[2]

^[4] ^[6] ^[9]

Meet the patient

A 70-year-old woman arrives from the emergency department with confusion, fever, and a blood pressure of 80/45. She has had dysuria and flank pain for two days. Her lactate is 4.8, her MAP is 57, and she will need noradrenaline before the hour is out. The question on the ward round is not whether she is septic — it is whether you can deliver the five actions of the Hour-1 bundle before the clock runs out.^[1]

Sepsis is the infection that has outrun the host. Every minute you spend deliberating is a minute the bacteria are not covered, and the data are unforgiving: survival drops roughly 7.6 percent for each hour antibiotics are delayed after hypotension begins.^[1]^[18]

References26Show

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