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ACC review series 2026: sepsis 1

Managing sepsis in the era of precision medicine: a narrative review: Ho Jin Yong, Sung Min Kim, Dohhyung Kim; Acute Crit Care. 2026;41(2):189-200. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.000884

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Abstract PDF: For decades, the management of sepsis has adopted protocolized care bundles. However, the plateau in global survival rates suggests that the "one-size-fits-all" paradigm exemplified by early goal-directed therapy has reached its limits. The physiological and biological heterogeneity of sepsis necessitates a fundamental shift toward precision medicine. This review examines the transition from empirical resuscitation to individualized care across four critical domains. First, fluid strategy is evolving from aggressive loading to dynamic stewardship. Current evidence favors balanced crystalloids over saline and advocates restrictive dosing guided by dynamic responsiveness indices and venous congestion assessments to prevent iatrogenic harm. Second, hemodynamic support is shifting toward a catecholamine‑sparing strategy. To mitigate the metabolic and immunologic toxicities of high-dose norepinephrine, multimodal vasopressors, such as vasopressin and angiotensin II, are used to target specific biological phenotypes, such as high-renin states. Third, antibiotic management balances rapid administration with rigorous stewardship through pharmacokinetic optimization, including continuous infusions, diagnostic pauses for stable patients, and short-course regimens. Finally, corticosteroid therapy is moving beyond universal debate toward targeted application. Emerging data support their use in specific responder phenotypes, notably severe community-acquired pneumonia and distinct transcriptomic endotypes. In conclusion, modern critical care is moving beyond rigid protocols toward a personalized framework. By integrating bedside biomarkers and clinical phenotypes, clinicians can deliver “the right drug, at the right dose, for the right patient," thereby optimizing outcomes in sepsis and septic shock.

Editorial

Ethics
End-of-life care in the intensive care unit: the optimal process of decision to withdrawing life-sustaining treatment based on the Korean medical environment and culture: Ho Jin Yong, Dohhyung Kim; Acute Crit Care. 2024;39(2):321-322. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00675

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Clinical Characteristics and Outcomes of Life-sustaining Treatment Withdrawal in a Korean Neurocritical Care Unit: A Single-center Retrospective Study
Junho Seong, Hye-in Chung, Jin-Heon Jeong, Jung Hwa Seo, Dae-Hyun Kim, Yong-Hwan Cho, Jae Hyung Choi, Jae-Kwan Cha
Journal of the Korean Neurological Association.2026; 44(1): 47. CrossRef

Review Article

Basic Science and Research
Sex or gender differences in treatment outcomes of sepsis and septic shock: Seung Yeon Min, Ho Jin Yong, Dohhyung Kim; Acute Crit Care. 2024;39(2):207-213. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2024.00591

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Gender disparities in intensive care unit (ICU) treatment approaches and outcomes are evident. However, clinicians often pay little attention to the importance of biological sex and sociocultural gender in their treatment courses. Previous studies have reported that differences between sexes or genders can significantly affect the manifestation of diseases, diagnosis, clinicians' treatment decisions, scope of treatment, and treatment outcomes in the intensive care field. In addition, numerous reports have suggested that immunomodulatory effects of sex hormones and differences in gene expression from X chromosomes between genders might play a significant role in treatment outcomes of various diseases. However, results from clinical studies are conflicting. Recently, the need for customized treatment based on physical, physiological, and genetic differences between females and males and sociocultural characteristics of society have been increasingly emphasized. However, interest in and research into this field are remarkably lacking in Asian countries, including South Korea. Through this review, we hope to enhance our awareness of the importance of sex and gender in intensive care treatment and research by briefly summarizing several principal issues, mainly focusing on sex and sex hormone-based outcomes in patients admitted to the ICU with sepsis and septic shock.

Citations

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