The evolution of sepsis care: from protocol-driven management to personalized intensive care
7 affiliations
- 1Deutsche Sepsis-Gesellschaft, Berlin, Germany
- 2Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Ruhr-Universität Bochum, Knappschaft Kliniken Universitätsklinikum Bochum, Bochum, Germany
- 3Ruhr-Universität Bochum Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Knappschaft Kliniken - Universitätsklinikum Bochum, In der Schornau 23-25, 44892 Bochum, Germany
- 4Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Heidelberg, Germany
- 5Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
- 6Institut für Intensivmedizin des Universitätsspital Zürich, Zürich, Switzerland
- 7Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Germany
Abstract
Purpose: Sepsis remains one of the leading causes of morbidity and mortality worldwide. Despite evolving supportive therapeutic strategies, outcomes, particularly in severe disease manifestations, remain unsatisfactory. In recent years, the conceptual understanding of sepsis has undergone a fundamental shift: from a uniform disease entity to a heterogeneous syndrome characterized by variable pathophysiology and diverse clinical trajectories. In parallel, key aspects of diagnosis and management have been re-evaluated in the context of recently updated guidelines as well as international consensus statements.
Methods: This review integrates recent guideline updates and emerging concepts in sepsis management into a clinically oriented synthesis. Particular focus is placed on evolving approaches to infection control, hemodynamic stabilization, tissue perfusion–oriented resuscitation, individualized antimicrobial strategies, and the concept of refractory septic shock.
Results: In the early phase, sepsis management continues to rely predominantly on standardized interventions focused on rapid infection control and hemodynamic stabilization. As the disease progresses, however, therapeutic strategies increasingly require continuous reassessment and adaptation to the individual patient context. Recent guideline developments therefore reflect a broader shift from rigid protocol-driven algorithms toward more flexible, context-sensitive, and physiology-guided approaches. A central component of this evolution is the growing emphasis on tissue perfusion–oriented resuscitation, individualized hemodynamic management, and risk-adapted antimicrobial strategies. Another important recent development is the proposed definition of refractory septic shock, which aims to identify a subgroup of patients with persistent hemodynamic instability and tissue hypoperfusion despite guideline-based initial therapy. Beyond its prognostic relevance, this concept may provide a pragmatic framework for structured therapeutic escalation and phenotype-guided treatment strategies.
Conclusion: Overall, contemporary sepsis care is evolving toward a staged management model in which standardized early interventions are increasingly complemented by individualized and dynamically adapted therapeutic decisions during later disease stages. Building on these developments, this review integrates recent guideline updates and emerging concepts into a clinically oriented synthesis and discusses their implications for personalized and phenotype-guided sepsis care.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02852-5.
Related
- Nurse Competencies, Patient Characteristics, and Pain Management Protocol Adherence in Intensive Care Units: A Multicenter Cross‐Sectional Study Accounting for ICU Clustering
- Development of a Novel Real-Time Computer-Assisted Colonoscopy Diagnostic Tool for Colorectal Neoplasia and Cancer to Enable Personalized Patient Management: Protocol for a Multicenter Proof-of-Concept Study.
- Platelet trajectory subphenotypes in intensive care patients with sepsis-induced coagulopathy
- Evaluation of a personalized total iodine dose (TID) combined with fixed injection duration (FID) protocol using high-concentration (400 mgI/mL) iodinated contrast medium in CT portal venography: a randomized trial
- Efficacy of a personalized, response-based transdiagnostic intervention for emotional disorders delivered via the Internet: a protocol for an adaptive randomized controlled trial
BibTeX
@article{rahmel2026evolution,
title = {{The evolution of sepsis care: from protocol-driven management to personalized intensive care}},
author = {Tim Rahmel and Benedikt H. Siegler and Markus A. Weigand and Patrick Meybohm and Sascha David and Frank Brunkhorst and Mathias Pletz and Michael Adamzik},
journal = {Infection},
year = {2026},
month = jun,
doi = {10.1007/s15010-026-02852-5},
url = {https://doi.org/10.1007/s15010-026-02852-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The evolution of sepsis care: from protocol-driven management to personalized intensive care
AU - Tim Rahmel
AU - Benedikt H. Siegler
AU - Markus A. Weigand
AU - Patrick Meybohm
AU - Sascha David
AU - Frank Brunkhorst
AU - Mathias Pletz
AU - Michael Adamzik
PY - 2026
DA - 2026/06/01
JO - Infection
DO - 10.1007/s15010-026-02852-5
UR - https://doi.org/10.1007/s15010-026-02852-5
AB - Purpose: Sepsis remains one of the leading causes of morbidity and mortality worldwide. Despite evolving supportive therapeutic strategies, outcomes, particularly in severe disease manifestations, remain unsatisfactory. In recent years, the conceptual understanding of sepsis has undergone a fundamental shift: from a uniform disease entity to a heterogeneous syndrome characterized by variable pathophysiology and diverse clinical trajectories. In parallel, key aspects of diagnosis and management have been re-evaluated in the context of recently updated guidelines as well as international consensus statements. Methods: This review integrates recent guideline updates and emerging concepts in sepsis management into a clinically oriented synthesis. Particular focus is placed on evolving approaches to infection control, hemodynamic stabilization, tissue perfusion–oriented resuscitation, individualized antimicrobial strategies, and the concept of refractory septic shock. Results: In the early phase, sepsis management continues to rely predominantly on standardized interventions focused on rapid infection control and hemodynamic stabilization. As the disease progresses, however, therapeutic strategies increasingly require continuous reassessment and adaptation to the individual patient context. Recent guideline developments therefore reflect a broader shift from rigid protocol-driven algorithms toward more flexible, context-sensitive, and physiology-guided approaches. A central component of this evolution is the growing emphasis on tissue perfusion–oriented resuscitation, individualized hemodynamic management, and risk-adapted antimicrobial strategies. Another important recent development is the proposed definition of refractory septic shock, which aims to identify a subgroup of patients with persistent hemodynamic instability and tissue hypoperfusion despite guideline-based initial therapy. Beyond its prognostic relevance, this concept may provide a pragmatic framework for structured therapeutic escalation and phenotype-guided treatment strategies. Conclusion: Overall, contemporary sepsis care is evolving toward a staged management model in which standardized early interventions are increasingly complemented by individualized and dynamically adapted therapeutic decisions during later disease stages. Building on these developments, this review integrates recent guideline updates and emerging concepts into a clinically oriented synthesis and discusses their implications for personalized and phenotype-guided sepsis care. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02852-5.
SN - 0300-8126
SN - 1439-0973
ER -