Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Abstract

Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

BTreatment review of hospital acquired infections

“…Some authors suggest evaluating the inferior vena cava with an ultrasound to assess fluid benefit to help avoid over-resuscitation [15,17]. Lactate may be used as a guide in determining adequate tissue perfusion, though it is not a direct measurement of this marker [14,18]. An important factor in sepsis, as well as antimicrobial stewardship, is to collect appropriate cultures prior to initiation of antimicrobial therapy to prevent sterilization [14].…”

“…Lactate may be used as a guide in determining adequate tissue perfusion, though it is not a direct measurement of this marker [14,18]. An important factor in sepsis, as well as antimicrobial stewardship, is to collect appropriate cultures prior to initiation of antimicrobial therapy to prevent sterilization [14]. De-escalating therapy is essential in decreasing resistance, side effects, and costs.…”

“…In cases where timely collection of specimens is not feasible, it may be more beneficial to administer therapy than to prolong treatment. At least two sets of 20-30 mL of blood per culture, aerobic and anaerobic, should be obtained subsequently within a short interval time due to extreme urgency [14,19]. Once sepsis or septic shock is determined, intravenous (IV) administration of empiric antibiotics is recommended within one hour [14].…”

“…The Surviving Sepsis Campaign of 2016 [14] recommends that in the presence of hypoperfusion, fluid resuscitation with a crystalloid be given at a volume of 30 mL kg -1 within the first 3 h, though controversial. It is imperative to modify the volume of fluid resuscitation in identified patients [15].…”

“…Some patients may require more, or less, fluid and should be clinically evaluated based on heart rate, blood pressure, oxygen saturation, urine output, capillary refill, appearance of skin mottling, etc. [14,15]. Crystalloid fluid may be given in 500 mL challenges adding up to an initial resuscitation of 20-30 mL kg −1 , measuring responsiveness by an increase in stroke volume [15,16].…”