ABSTRACT
In the UK, the incidence of severe sepsis in adult intensive-care units is 27.7%, which amounts to about 23,211 cases per year. Sepsis is among the leading causes of preventable maternal death not only in developing countries, but in developed countries as well. Evolving inflammatory responses can trigger pathophysiological changes that lead to severe sepsis. Sepsis is also accompanied by activation of the coagulation cascade via tissue factor- and factor VII-dependent generation of thrombin. In early sepsis, low blood pressure and high heart rate are associated with a high cardiac output and a low peripheral vascular resistance, with warm peripheries and bounding pulses. In contrast, late sepsis presents with a low cardiac output and high systemic vascular resistance - these patients are peripherally cold, sweaty, have weak, thready pulses and need urgent resuscitation. Intravenous antibiotic therapy should be started within the first hour of recognition of severe sepsis, after appropriate cultures have been obtained.
