Management of sepsis following injury.

Sepsis is a significant cause of late morbidity and mortality in the severely injured patient. In addition to the risk factors of shock, multiple transfusions, and contamination, the trauma patient may have the additional factor of severe immunologic depression. The prevention of sepsis should be an early consideration. Invasive diagnostic and therapeutic maneuvers should be limited to those that are absolutely necessary, since the incidence of nosocomial infection is high. Prophylactic antibiotics should not be misused, as these may increase the risk of serious, resistant infections. Frequent examination of sputum smears may allow the early diagnosis of pneumonia. Nutritional supplementation can improve host defenses, and should be instituted early. The patient in septic shock should be resuscitated and stabilized in the intensive care unit. Monitoring should include determination of cardiac index and systemic oxygen consumption. Computed tomography has emerged as the primary modality for the diagnosis of intra-abdominal sepsis. When combined with percutaneous drainage of abscesses, it represents a rapid and safe approach to the diagnosis and treatment of the critically ill septic patient. In certain cases, such as bowel perforation or necrosis, anastomotic breakdown, or acalculous cholecystitis, laparotomy is the procedure of choice. Opportunistic infections may become significant in patients who have required a prolonged course of treatment. In the patient with multiple organ-system failure who is not responding to therapy and in whom no clear source of sepsis has been identified, exploratory laparotomy should be considered. Antibiotics should be used with caution and should not started in every patient with a fever. Their use should be directed by appropriate cultures and sensitivities.(ABSTRACT TRUNCATED AT 250 WORDS)