Surviving Sepsis Campaign Guidelines 2021: summary
Initial Resuscitation:
- Fluid Resuscitation: Administer at least 30 mL/kg of IV crystalloid fluid within the first 3 hours.
- Vasopressors: Use norepinephrine to maintain mean arterial pressure (MAP) ≥ 65 mm Hg.
Antimicrobial Therapy:
- Timing: Administer broad-spectrum antimicrobials within 1 hour of recognising sepsis or septic shock.
- Adjustment: Tailor therapy based on culture results and clinical response.
Hemodynamic Support:
- Fluid Management: Prefer dynamic over static measures to guide resuscitation.
- Vasopressors: Start with norepinephrine; consider adding vasopressin or epinephrine if necessary.
Ventilation:
- Mechanical Ventilation: For sepsis-induced ARDS, use low tidal volumes of 6 mL/kg of predicted body weight and maintain plateau pressures ≤ 30 cm H₂O.
Blood Products:
- Transfusion: Transfuse when haemoglobin (Hb) levels fall below 7.0 g/dL, unless there is active bleeding, severe hypoxemia, or ischemic heart disease
Adjunctive Therapies:
- Corticosteroids: Consider IV hydrocortisone at 200 mg/day for refractory septic shock.
- Glucose Control: Maintain blood glucose ≤ 10 mmol/L.
Organ Support:
- Renal Replacement Therapy: Use continuous or intermittent renal replacement therapy as needed.
- VTE Prophylaxis: Provide pharmacologic prophylaxis against venous thromboembolism (VTE) unless contraindicated.
- Stress Ulcer Prophylaxis: Provide prophylaxis for patients at risk for gastrointestinal bleeding.
Nutrition:
- Early Enteral Feeding: Start enteral feeding within 48 hours rather than parenteral nutrition.
Goals of Care:
- End-of-Life Care: Discuss prognosis and treatment goals with patients and families, incorporating palliative care as appropriate.
These guidelines emphasise early and aggressive management to improve outcomes. For further details, refer to the Surviving Sepsis Campaign 2021 Guidelines.