Early recognition and treatment of severe sepsis and septic shock in CAP

Community-acquired pneumonia is one of the most common causes of severe sepsis and septic shock, accounting for up to 45% of cases admitted to hospitals. Early identification and illness severity stratification followed by early intervention using a bundled treatment approach have been shown to improve outcomes. This includes blood cultures before antibiotics, fluid resuscitation with 30 mL kg^-1 body weight to target a mean arterial blood pressure of at least 65 mmHg, central venous pressure between 8 and 12 mmHg, and a central venous oxygen saturation of 70% within 6 h of diagnosis. In addition, early and appropriate introduction of ventilator assistance not only improves gas exchange, it further reduces the imbalance between oxygen delivery and utilisation. The mortality reduction is also accompanied by a decrease in duration of mechanical ventilation, vasopressor use, and intensive care unit and hospital length of stay.