Nutritional support in septic shock has changed considerably over the past two decades. Reliance on total parenteral nutrition has given way to early and extensive use of enteral hyperalimentation. Enteral feeding of septic patients has been shown to benefit enterocyte function, help maintain the intestinal permeability barrier, and help prevent gut-derived endotoxin and cytokine generation. Nutritional supplementation with glutamine, arginine, and omega-3 fatty acids has experimental support and is increasingly being used in septic patients. The incremental value of such enriched enteral formulations over standard enteral alimentation has not yet been confirmed in large clinical trials.
Fever is a common concomitant of severe sepsis and appears to be an advantageous response.
Heat shock proteins function as intracellular chaperones to stabilize and prevent denaturation of host proteins. Heat shock protein induction may actually decrease the mortality associated with experimental endotoxin challenge. Efforts to lower body temperature with cooling blankets are largely ineffective and may not benefit the patient in septic shock. This strategy should generally be avoided unless true hyperthermia is present. In septic shock, combinations of bactericidal antimicrobial agents are generally given on an empirical basis.