Sepsis and septic shock: new guidelines for clinical management
Updated international guidelines for sepsis and septic shock emphasize frequent patient re-evaluation and patient-specific tailoring of hemodynamic therapy.
New guidelines for sepsis and septic shock emphasize frequent patient re-evaluation and patient-specific tailoring of hemodynamic therapy. The guidelines were presented at the 46th Annual Meeting of the Society of Critical Care Medicine (SCCM) and were published online in Critical Care Medicine and Intensive Care Medicine.
The guidelines, developed by the SCCM and the European Society of Intensive Care Medicine, serve as an update to the “Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012.” The international panel was grouped into 5 sections— hemodynamics, infection, adjunctive therapies, metabolic, and ventilation—and provided 93 statements on early management and resuscitation of patients with sepsis or septic shock.
The recommendations, according to the panel, include the following:
- Sepsis and septic shock are medical emergencies, and we recommend that treatment and resuscitation begin immediately (best practice statement [BPS]).
- We recommend that, in the resuscitation from sepsis-induced hypoperfusion, at least 30 mL/kg of IV crystalloid fluid be given within the first 3 hours (strong recommendation, low quality of evidence).
- We recommend that, following initial fluid resuscitation, additional fluids be guided by frequent reassessment of hemodynamic status (BPS).
- We recommend further hemodynamic assessment (such as assessing cardiac function) to determine the type of shock if the clinical examination does not lead to a clear diagnosis (BPS).
- We suggest that dynamic over static variables be used to predict fluid responsiveness, where available (weak recommendation, low quality of evidence).
- We recommend an initial target mean arterial pressure (MAP) of 65 mm Hg in patients with septic shock requiring vasopressors (strong recommendation, moderate quality of evidence).
- We suggest guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion (weak recommendation, low quality of evidence).
Screening for sepsis and performance improvement
- We recommend that hospitals and hospital systems have a performance improvement program for sepsis, including sepsis screening for acutely ill, high-risk patients (BPS).
- We recommend that appropriate routine microbiologic cultures (including blood) be obtained before starting antimicrobial therapy in patients with suspected sepsis or septic shock if doing so results in no substantial delay in the start of antimicrobials (BPS).