Editing Sepsis (section)

=== Anesthesia ===
A target [[tidal volume]] of 6 mL/kg of predicted body weight (PBW) and a [[plateau pressure]] less than 30&nbsp;cm H<sub>2</sub>O is recommended for those who require [[mechanical ventilation|ventilation]] due to sepsis-induced severe ARDS. High [[positive end expiratory pressure]] (PEEP) is recommended for moderate to severe ARDS in sepsis as it opens more lung units for oxygen exchange. Predicted body weight is calculated based on sex and height, and tools for this are available.<ref name="Ardsnet"/> Recruitment maneuvers may be necessary for severe ARDS by briefly raising the transpulmonary pressure. It is recommended that the head of the bed be raised if possible to improve ventilation. However, [[beta2-adrenergic agonist|β2 adrenergic receptor agonists]] are not recommended to treat ARDS because it may reduce survival rates and precipitate [[Heart arrhythmia|abnormal heart rhythms]]. A [[spontaneous breathing trial]] using [[continuous positive airway pressure]] (CPAP), T piece, or inspiratory pressure augmentation can help reduce the duration of ventilation. Minimizing intermittent or continuous sedation helps reduce the duration of mechanical ventilation.<ref name="SSC–G2016"/>

General anesthesia is recommended for people with sepsis who require surgical procedures to remove the infective source. Usually, inhalational and intravenous anesthetics are used. Requirements for anesthetics may be reduced in sepsis. [[Inhalational anaesthetic|Inhalational anesthetics]] can reduce the level of proinflammatory cytokines, altering leukocyte adhesion and proliferation, inducing [[apoptosis]] (cell death) of the lymphocytes, possibly with a toxic effect on [[mitochondria]]l function.<ref name="Yuki"/> Although [[etomidate]] has a minimal effect on the cardiovascular system, it is often not recommended as a medication to help with [[intubation]] in this situation due to concerns it may lead to [[adrenal insufficiency|poor adrenal function]] and an increased risk of death.<ref name=Cherfan2012/><ref name=Chan2012/> The small amount of evidence there is, however, has not found a change in the risk of death with etomidate.<ref name=Gu2015/>

[[Neuromuscular-blocking drug|Paralytic agents]] are not suggested for use in sepsis cases in the absence of [[Acute respiratory distress syndrome|ARDS]], as a growing body of evidence points to reduced durations of [[mechanical ventilation]], ICU and hospital stays.<ref name=SSCG2012/> However, paralytic use in [[Acute respiratory distress syndrome|ARDS]] cases remains controversial. When appropriately used, paralytics may aid successful mechanical ventilation, however, evidence has also suggested that mechanical ventilation in severe sepsis does not improve oxygen consumption and delivery.<ref name=SSCG2012/>