Phys · infectious
Sepsis and Septic Shock
Also known as sepsis · septic shock · septicaemia · bacteraemia with organ dysfunction · severe sepsis (deprecated) · systemic inflammatory response syndrome (SIRS, historical)
Consultant-physician-depth guide to sepsis and septic shock — Sepsis-3 definitions (SOFA, qSOFA), pathophysiology of the dysregulated host response, Surviving Sepsis Campaign Hour-1 Bundle, vasopressor escalation, fluid responsiveness, source control, supportive care, and special situations (neutropenic sepsis, pregnancy, cirrhosis) — structured for FRACP DWE and DCE preparation.
Checked against its sources on 2 Sept 2026
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Target exams
Red flags
- Septic shock — vasopressor requirement to maintain MAP 65 or above with lactate above 2 after fluid resuscitation: mortality 30 to 40 per cent
- Lactate above 4 mmol/L — marker of tissue hypoperfusion; triggers immediate resuscitation
- Altered mentation with infection — septic encephalopathy; independent predictor of mortality
- Delayed antibiotics beyond 1 hour in septic shock — each hour of delay increases mortality
- Mottling or prolonged capillary refill (above 3 seconds) — sign of impaired peripheral perfusion and ongoing shock
- Dual acid-base disorder (metabolic acidosis with elevated lactate and respiratory alkalosis) — classic sepsis fingerprint
Sepsis and Septic Shock
Meet the patient
A 68-year-old man arrives from a nursing home with three days of dysuria and worsening confusion. His respiratory rate is 28, blood pressure 84/50 after a litre of saline, lactate 4.2, and he cannot tell you the year. The registrar wants to "see if the fluids work first."[1]
They will not — not in time. This patient already meets the definition of septic shock: hypotension plus a lactate above 2 mmol/L despite 30 mL/kg of fluid. The Hour-1 Bundle starts now, the antibiotics go in within the hour, and norepinephrine is running before the cultures return. Everything below is a refinement on those five moves.[4]
References14ShowHide
- [1]Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903338
- [14]Abraham E. New Definitions for Sepsis and Septic Shock: Continuing Evolution but With Much Still to Learn JAMA, 2016.PMID 26903333
- [2]Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903335
- [3]Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903336
- [4]Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 Intensive Care Med, 2021.PMID 34599691
- [5]Levy MM, Evans LE, Rhodes A The Surviving Sepsis Campaign Bundle: 2018 update Intensive Care Med, 2018.PMID 29675566
- [6]Seymour CW, Gesten F, Prescott HC, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis N Engl J Med, 2017.PMID 28528569
- [7]Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock N Engl J Med, 2014.PMID 25272316
- [8]Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus Fludrocortisone for Adults with Septic Shock N Engl J Med, 2018.PMID 29490185
- [9]Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock N Engl J Med, 2008.PMID 18184957
- [10]Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock JAMA, 2002.PMID 12186604
- [11]Moskowitz A, Huang DT, Hou PC, et al. Effect of Ascorbic Acid, Corticosteroids, and Thiamine on Organ Injury in Septic Shock: The ACTS Randomized Clinical Trial JAMA, 2020.PMID 32809003
- [12]Iwashyna TJ, Ely EW, Smith DM, Langa KM Long-term cognitive impairment and functional disability among survivors of severe sepsis JAMA, 2010.PMID 20978258
- [13]Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america Clin Infect Dis, 2011.PMID 21258094