Sepsis is a life-threatening condition characterized by immune system dysregulation whose pathophysiology still remains incompletely understood. Better outcomes in patients with sepsis have not been reached despite guidelines updates, development of rapid diagnostic tests, and proper hemodynamic and antimicrobial management. Blood cultures are time-consuming and may delay important therapeutic decisions. Nonculture-based techniques overcome some limitations seen with culture-based techniques with early phenotypic identification of resistance remaining as the cornerstone of optimal diagnosis. A new paradigm has started adjusting preemptive therapy for cytomegalovirus (CMV) infection among kidney transplant patients based on monitoring the host immune response. In this review from a PubMed literature search in adults with sepsis or septic shock, we identified newer tests and highlight some advances in monitoring the host immune response for personalized adjunctive therapy. Monitoring the individual host immune response at the bedside is an unmet clinical need to guide immunomodulatory therapy. The coronavirus disease 2019 pandemic has led to a further understanding of the complex immunopathology of sepsis and opened new avenues for mitigating immune dysregulation. In this review, we discuss current evidence regarding the immune response to sepsis along with challenges and directions for future research.

Sepsis is a syndrome initiated by an infection in which an aberrant host response to the initiating microbe leads to organ dysfunction, and, all too frequently, mortality. An enormous increase in our understanding of sepsis has occurred over the past 25 years. Unfortunately, this increase has not been matched by successful new therapies, and sepsis treatment continues to be centered on timely antibiotics and supportive care. The Surviving Sepsis Campaign has focused practitioners on bundles for quality improvement and guidelines for bedside management. Adhering to standardized care has been associated with improvements in patient outcome. The mainstays of sepsis management, including diagnosis, fluid resuscitation, antimicrobial management, and vasopressors, are critical to successfully treating patients with sepsis and septic shock and play a major role in determining outcome from sepsis. At the same time, there is increasing recognition that a “one size fits all” model cannot always be the best approach to patient management because of the inherent heterogeneity associated with sepsis, both in terms of initiating microbe and the host response. Further, identifying new targets for therapy may allow for improved outcomes. This review study serves to highlight the past and present facets of early clinical management of septic patients and then illustrate future directions that will hopefully improve outcomes in this common and lethal syndrome.

Acute pancreatitis (AP) is one of the common gastrointestinal diseases requiring hospitalization. Once AP develops into severe AP, the mortality markedly increases. Animal studies have confirmed that thoracic epidural analgesia (TEA) has many benefits for AP and can provide the survival rate of experimental animals. Existing clinical studies have also shown the safety and effectiveness of TEA in AP. This paper reviews the potential benefits and possible mechanisms of TEA for AP.

Diaphragm weakness develops in up to 80% of the critically ill patients, and is associated with adverse clinical outcomes. Mechanical ventilation has been proposed to play a role in the development of diaphragm weakness in critically ill patients, especially by ventilator under-assist or ventilator over-assist. Therefore, in addition to the concept of lung-protective ventilation to protect the lung, diaphragm-protective ventilation has been recently proposed to limit the development of diaphragm weakness. In this concise review, we will discuss the current evidence for diaphragm-protective ventilation and the clinical consequences.