Wednesday, March 6, 2013

Surviving Sepsis Campaign

Surviving Sepsis Campaign


The Surviving Sepsis Campaign came out with updated guidelines for the management of severe sepsis and Septic shock in 2012. Here is a summary. Please refer to this link to access the entire article: Surviving Sepsis Campaign

A. Initial Resuscitation:
  • Recognize septic shock: defined as documented hypotension despite adequate fluid challenge and evidence of end organ hypoperfusion (lactate >4g, AKI, change in LOC, cardiac ischemia)
  • Goals for the first 6 hrs:
    • CVP 8-12mmHg
    • MAP 65mmHg or greater
    • Urine output goal 0.5mL/kg/hr
    • Central venous saturation 70% or mixed venous O2 sat of 65%
    • Target resuscitation to the normalization of lactate
B. Diagnosis:
  • Septic w/u: cultures should be drawn prior to antibiotic administration anaerobic/aerobic at least one peripherally and one from all central lines
  • If fungal infection/candidiases is suspected: use 1,3 beta-D-glucan assay, mannan and anti-mannan antibody assays
  • Imagine as needed to investigate source
C. Empiric Therapy
  • Administer IV abx within first hour of recogntition of shock.
  • Think about potential bugs and penetration of IV abx
  • Combination therapy for severe sepsis/neutropenic patients is recommended for up to 3-5 days but should be narrowed thereafter. Consider combo therapy for pseudomonas, acinetobacter and other multi-drug resistant organisms (i.e. an extended spectrum beta lactamase and gentamycin or flouroquinolone)
D. Get Source Control
  • Every effort should be made to get source control within 12 hrs of identification, this may involve getting the surgeons or interventional radiology involved. Abx treatment should be limitted to 7-10 days, unless there was slow response to abx
  • For example, infected peripancreatic abscess or infected necrotizing pancreatitis should be drained percutaneously or surgically once viable and non-viable tissue is demarcated.
  • If percutaneous devices are a possible source infection, they should be removed promptly!
E. Infection Prevention:
  • Selective oral and or digestive decontamination should be used i.e. oral chlorhexidine

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