Evidence based medicine in the Intensive Care Unit: Improving care for the septic patient

Evidence based medicine (EBM) introduces a systematic approach to caring for patients that integrates scientific evidence with pathophysiologic reasoning, personal experience and patient values. Published reports are accumulating for the treatment of sepsis and septic shock. Using a case-based approach, we sought to review the evidence, specifically the use of early goal-directed therapy, appropriate and timely administration of broad spectrum antibiotics, availability of blood culture results, source control, appropriate assessment for activated protein C, appropriate assessment for and treatment of adrenal insufficiency, and intensive insulin therapy. Incorporation of evidence based interventions, in addition to active research into the pathogenesis and treatment of severe sepsis and septic shock may reduce the unacceptably high mortality of this disease.