In our new article, Prof. Dejan Markovic, Head of the Anesthesia Department at the Clinic for Cardiac Surgery, Clinical Centre of Serbia, and Dr. Jovana Avramović Stanisavljević, Assistant Director of the Center for Anesthesiology and Reanimatology, Clinical Centre of Serbia, share their perspectives on the evolving approach to sepsis care.

“First encounter with sepsis was early in residency, when I cared for a young patient who developed fulminant septic shock. What left the strongest impression was how difficult it was to recognise — the first sign was altered mental status, which, back then, was not how I had learned to think about sepsis. As the septic shock progressed, profound vasoplegia rapidly affected virtually every organ system, with acute kidney injury, ARDS and severe haematological disturbances. The clinical picture changed from minute to minute, and the treatment became a nearly two-month-long battle, complicated by reinfections, relapses and ICU-acquired weakness. Despite everything we could do, the patient eventually died.

That experience stayed with me, shaping how I approach sepsis as a dynamic, multisystem disease that demands constant reassessment and adaptation. What continues to motivate is how much our ability to recognise and treat sepsis has evolved. Despite advances in diagnostics, antibiotics, monitoring and organ support, bacteria continue to evolve and find new ways to escape our treatment. This constant race between medical progress and microbial resistance reminds us that we must keep learning and adapting.

In our ICU, multimodal haemoadsorption and extracorporeal blood purification are an important — and in selected cases potentially life-saving — part of the treatment strategy. These approaches are considered for severe septic shock, other forms of refractory vasoplegia, severe organ injury related to ischemia and reperfusion, or complex infections, especially when conventional treatment is not enough to control the overwhelming pathophysiological response.

The key challenge is identifying the patient who is most likely to benefit. We still do not have a simple way to recognise the hyperinflammatory phenotype at the bedside, or to define the exact moment when extracorporeal blood purification is most likely to be effective. The key is to integrate them with source control, appropriate antimicrobial therapy and organ support. Patient selection and, perhaps even more importantly, timing are essential.

We tend to consider haemoadsorption earlier when the clinical picture and overall trajectory suggest that the patient may benefit, rather than waiting until all other options have been exhausted. In our experience, we often see a reduction in vasopressor requirements, improved haemodynamic stability and a decline in inflammatory markers, including IL-6I see this as giving other treatments time to work.

We still lack strong randomised evidence to clearly identify who benefits most, and concerns remain about cost-effectiveness and the potential removal of therapeutic drugs, including antimicrobials. But clinical experience is growing, and we are becoming more familiar with how to integrate these therapies into a broader treatment strategy. For me, the most important change is that we no longer think only about whether to start a device. We think about which patient, which phenotype, and which moment.

One of the most exciting changes in sepsis management is the move away from rigid, one-size-fits-all protocols towards more personalised and dynamic care. Sepsis is not the same disease in every patient, and even within the same patient, its biology can change over time. Combining clinical data with biomarkers, rapid microbiological diagnostics, artificial intelligence and, eventually, multi-omics profiling will help us recognise these differences earlier and better understand the biological phenotype of each patient.

Over the next decade, I think the biggest impact will come from earlier diagnosis, more personalised treatment and better systems of care. AI, advanced monitoring and rapid microbiological diagnostics may help us recognise deterioration earlier and help us understand which patients are most likely to benefit from a specific treatment.

But technology alone will not solve the problem. Strong infection prevention, antimicrobial stewardship, effective source control and continuous education remain essential. Ultimately, sepsis care depends on coordinated decisions: from the surgeon controlling the source of infection, to nurses preventing transmission and recognising deterioration, to intensivists continuously reassessing the patient and adapting treatment.

To me, “Never Stop Fighting Sepsis” means never stop reassessing, learning and adapting — staying ahead of new evidence and emerging threats, preventing infection, embracing new technologies, and building a multidisciplinary team that is ready to make the right decision for each patient, at the right time.”