Sepsis

Here is another of many sepsis reviews, this one published in Clinics in Chest Medicine. It is a comprehensive evidence based review although it does not take into account NICE-SUGAR and the recent systematic review regarding steroids. Although the paper resembles many other recent sepsis reviews these statements on acidosis and nutrition are interesting in that they challenge popular practice:

Even though experimental data do not support the practice, as a practical matter, many physicians feel compelled to intervene when pH declines below 7.10.

And---

As with other critically ill patients, there are two basic “truths” about nutrition. First, prolonged starvation (weeks to months) is fatal, and second, any patient can tolerate a few days without feeding. Almost every other aspect of nutritional support is argued.

This was new to me:

At this time, there is no compelling evidence to suggest that any particular enteral feeding formula or particular balance of components is superior to another for the patient with severe sepsis, but there are compelling phase II data from patients with acute lung injury. Three trials now suggest that an enteral formula enriched with omega-3 fatty acids, antioxidants, and other specialized ingredients may improve outcomes. ^{[120] , [121] , [122]}