Adjunct therapy for sepsis: how early?

Sepsis is a leading cause of death worldwide. The management of patients is primarily based on curing the infectious process with anti-infective drugs and/or surgical drainage. Simultaneously, treatment includes optimization of oxygen use by tissues via appropriate oxygen therapy and respiratory and hemodynamic management. At best, initiating appropriate anti-infective and symptomatic treatments should lead to patient improvement within a few hours. Activated protein C and hydrocortisone are the only two available adjunct therapies for sepsis. These treatments should optimally be started within 24 hours of the onset of shock. They should be initiated in those patients who did not adequately respond after 6 hours of optimal anti-infective and symptomatic treatments.