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Cited by 176Sepsis Diagnosis and TreatmentAbdominal Surgery and ComplicationsAntibiotics Pharmacokinetics and Efficacy

Recommendations for sepsis management in resource-limited settings

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Dünser, Martin W., Festic, Emir, Dondorp, Arjen, Kissoon, Niranjan, Ganbat, Tsenddorj, Kwizera, Arthur, Haniffa, Rashan, Baker, Tim +2 more·2012·Intensive Care Medicine
DOI 10.1007/s00134-012-2468-5PMC PMC3307996
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Abstract

PURPOSE: To provide clinicians practicing in resource-limited settings with a framework to improve the diagnosis and treatment of pediatric and adult patients with sepsis. METHODS: The medical literature on sepsis management was reviewed. Specific attention was paid to identify clinical evidence on sepsis management from resource-limited settings. RESULTS: Recommendations are grouped into acute and post-acute interventions. Acute interventions include liberal fluid resuscitation to achieve adequate tissue perfusion, normal heart rate and arterial blood pressure, use of epinephrine or dopamine for inadequate tissue perfusion despite fluid resuscitation, frequent measurement of arterial blood pressure in hemodynamically unstable patients, administration of hydrocortisone or prednisolone to patients requiring catecholamines, oxygen administration to achieve an oxygen saturation >90%, semi-recumbent and/or lateral position, non-invasive ventilation for increased work of breathing or hypoxemia despite oxygen therapy, timely administration of adequate antimicrobials, thorough clinical investigation for infectious source identification, fluid/tissue sampling and microbiological work-up, removal, drainage or debridement of the infectious source. Post-acute interventions include regular re-assessment of antimicrobial therapy, administration of antimicrobials for an adequate but not prolonged duration, avoidance of hypoglycemia, pharmacological or mechanical deep vein thrombosis prophylaxis, resumption of oral food intake after resuscitation and regaining of consciousness, careful use of opioids and sedatives, early mobilization, and active weaning of invasive support. Specific considerations for malaria, puerperal sepsis and HIV/AIDS patients with sepsis are included. CONCLUSION: Only scarce evidence exists for the management of pediatric and adult sepsis in resource-limited settings. The presented recommendations may help to improve sepsis management in middle- and low-income countries.

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  • Specialist consultation appears to be associated with improved patient outcomes for a variety of infectious syndromes.

    “Specialist consultation appears to be associated with improved patient outcomes for a variety of infectious syndromes (295-300).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [296]

    In General considerations (page unavailable), the paper recommends seeking medical review when a septic patient deteriorates and says transfer to a hospital with more medical expertise may save lives. It does not report an association between specialist consultation and improved outcomes across a variety of infectious syndromes; its recommendation concerns sepsis and is qualified by the risks of transfer. (LLM, conf=0.72)

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Cited by

Sorted by citations

Authors
Dünser, M. W., Festic, E., Dondorp, A., Kissoon, N., Ganbat, T., Kwizera, A., Haniffa, R., Baker, T., Schultz, M. J., & Global Intensive Care Working Group of the European Society of Intensive Care Medicine
Affiliations
  • Paracelsus Medical University (AT)
  • Mahidol University (TH)
  • University of British Columbia (CA)
  • Mulago Hospital (UG)
  • University College Hospital (GB)
  • Karolinska University Hospital (SE)
  • Amsterdam UMC Location University of Amsterdam (NL)
Corresponding author
Dünser, Martin W.
ORCID
Venue
Intensive Care Medicine
Publisher
Springer Science and Business Media LLC
Published
2012-02-14
Volume
38
Issue
4
Pages
557-574
ISSN
  • 0342-4642 (ISSN-L)
  • 1432-1238
DOI
10.1007/s00134-012-2468-5
PMC
PMC3307996
OpenAlex
W2093598389
Cited by
176
References
8
Citations by year
2026: 6 · 2025: 8 · 2024: 11 · 2023: 4 · 2022: 14 · 2021: 9 · 2020: 10 · 2019: 21 · 2018: 11 · 2017: 15 · 2016: 9 · 2015: 16 · 2014: 20 · 2013: 17 · 2012: 5
FWCI
13.89
Type
journal article
Language
en
Update notices
erratum (2012-03-10)
Open access
Licence
Locations
  • Intensive Care Medicine (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
Funders
Wellcome Trust (089275)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
  • Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
Keywords
sepsis treatment, resource-limited settings, pediatric sepsis, adult sepsis, fluid resuscitation, vasopressors, cortisol, oxygen therapy, non-invasive ventilation, antimicrobial therapy, source control, post-acute care, deep vein thrombosis prevention, malaria, puerperal fever, HIV/AIDS, low- and middle-income countries
MeSH terms
Critical Care, Developing Countries, Health Resources, Humans, Sepsis

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