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