Spectrum of sepsis, mediators, source control and management of bundles

Antonino Gullo, Alice Foti, Paolo Murabito, Giovanni Li Volti, Marinella Astuto, Carmela Stissi, Francesca Rubulotta, Filippo Sanfilippo, Cristina Santonocito, Gabriele Sganga, Giuseppe Ristagno

Research output: Contribution to journalArticlepeer-review


Sepsis is a modern medicine icon and the onset of organ dysfunction is one of the worst scenario. More than 100 distinct molecules have been proposed as useful biological markers of sepsis. TNF-alpha, IL-6, chemokines and cytokines are considered the first line factors able to drive the dynamic process of sepsis. The PIRO scheme is a new classification of different aspects, used to stage sepsis. Resuscitation bundles must be started within 6 hours of presentation (serum lactate measured; blood cultures obtained before antibiotic therapy; broad-spectrum antibiotics within 3 hours from emergency admission and 1 hour from ICU admission; in case of hypotension and/or lactate higher than 4 mmol/L deliver an initial 20 ml/kg of crystalloid or colloid solution or apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure above 65 mmHg). A management bundle should be implemented within 24 hour (low-dose steroids administered for septic shock; recombinant human activated protein C; glucose control maintained at less than 8.3 mmol/L; inspiratory plateau pressures maintained at less than 30 cm H 2O).

Original languageEnglish
Pages (from-to)906-911
Number of pages6
JournalFrontiers in Bioscience - Elite
Volume2 E
Issue number3
Publication statusPublished - Jun 1 2010


  • Classification
  • Clinical biomarkers
  • Sepsis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)
  • Medicine(all)


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