From Internal Wards to Intensive Care Units and backwards: the paths of the difficult patient

Sepsis-induced organ dysfunction may be occult; therefore, its presence should be considered in any patient presenting with infection. Conversely, unrecognized infection may be the cause of new-onset organ dysfunction. Any unexplained organ dysfunction should thus raise the possibility of underlying infection. Severe sepsis is a heterogeneous clinical entity with a wide spectrum of manifestations and severity, and over half of patients never receive care in an Intensive Care Unit (ICU). Due to ageing of the population, patients with severe sepsis are frequently admitted to general wards and, given the standard diagnostic approach, treatment must be tailored to the single patient, taking into account the burden of comorbidities. From Internal Medicine Wards the single patient could be transferred to ICU, but again admitted to our Units, due to his/her frailty, to complete the path of cure. First of all, we have to be aware of the illness and more, according to the recent literature, that, generally speaking, limits invasiveness, to be able to take care of this kind of patients.