UK Sepsis Trust

UK Sepsis Trust Guidelines

The UK Sepsis Trust provides comprehensive guidelines for the identification, treatment, and management of sepsis. These guidelines reflect the latest evidence and best practices, aiming to improve patient outcomes through early recognition and prompt intervention.

1. Identification of Sepsis:

Use of National Early Warning Score (NEWS2):

  • NEWS2 is recommended for assessing adult patients. It scores vital signs to determine the severity of illness and the need for clinical response.
  • Early Warning Scores for children (PEWS) are also being trialled.

Sepsis Red Flags:
Healthcare professionals should look for specific signs that indicate a high risk of sepsis, including:

  • Systolic blood pressure ≤ 90 mmHg
  • Heart rate > 130 beats per minute
  • Respiratory rate ≥ 25 breaths per minute
  • Oxygen saturation < 92% (or < 88% in chronic respiratory conditions)
  • Non-blanching rash, cyanosis, or mottled skin
  • Not passing urine in 18 hours
  • Lactate ≥ 2 mmol/L

2. Initial Management:

Sepsis Six Pathway:
A bundle of six critical actions to be initiated within one hour of suspecting sepsis:

  1. Administer oxygen to maintain saturation levels.
  2. Take blood cultures before starting antibiotics.
  3. Administer intravenous antibiotics.
  4. Start intravenous fluid resuscitation.
  5. Check lactate levels.
  6. Monitor urine output.

Fluid Resuscitation:

  • Administer at least 30 mL/kg of IV crystalloid fluids within the first three hours to maintain blood pressure and improve tissue perfusion.

Vasopressors:

  • If hypotension persists after fluid resuscitation, start norepinephrine to maintain a mean arterial pressure (MAP) ≥ 65 mmHg.

3. Antimicrobial Therapy:

Prompt Administration:

  • Administer broad-spectrum antibiotics within one hour of recognising sepsis.
  • Adjust antimicrobial therapy based on culture results to target specific pathogens, balancing effective treatment and antimicrobial stewardship.

4. Ongoing Management and Monitoring:

Haemodynamic Support:

  • Utilise dynamic measures over static ones to guide fluid resuscitation.
  • Consider additional vasopressors like vasopressin or adrenaline if required.

Organ Support:

  • Provide respiratory support through oxygen therapy or mechanical ventilation as necessary.
  • Implement renal replacement therapy for acute kidney injury.

5. Adjunctive Therapies:

Corticosteroids:

  • Use IV hydrocortisone (200 mg/day) for patients with refractory septic shock.

Glucose Control:

  • Maintain blood glucose levels ≤ 10 mmol/L.

6. Nutritional Support:

  • Start early enteral feeding within 48 hours to support metabolic needs and recovery.

7. Goals of Care:

  • Engage in discussions with patients and families about prognosis and treatment goals, incorporating palliative care where appropriate.

8. Education and Training:

  • Regular training and updates for healthcare professionals on the latest sepsis guidelines and best practices.

The guidelines emphasise the importance of early recognition, timely intervention, and ongoing management to improve patient outcomes. For detailed guidelines and resources, you can visit the UK Sepsis Trust Clinical Tools