New Surviving Sepsis Campaign Guidelines Released

[محمد ال عبدالله‎]

New Surviving Sepsis Campaign Guidelines Released

These updated guidelines for management of severe sepsis and septic shock are based on broad agreement among a large group of international experts.

Background and Purpose: While evidence remains weak for many aspects of care, these guidelines, updated from 2008 and developed independent of industry funding, represent the most up-to-date international consensus for optimal resuscitation of septic patients.

Key Points:

Resuscitation Goals in First 6 Hours

• Central venous pressure 8 to 12 mm Hg (grade 1C)
• Mean arterial pressure (MAP) 65 mm Hg (grade 1C)
• Urine output 0.5 mL/kg/hour (grade 1C)

Antimicrobials

• Intravenous administration within 1 hour of recognition of septic shock (grade 1B) and severe sepsis without septic shock (grade 1C)

Fluids

• Crystalloids as first choice for initial fluid resuscitation (grade 1B)
• Initial minimum crystalloid challenge of 30 mL/kg (grade 1C)

Vasopressors and Inotropes

• Norepinephrine as first choice (grade 1B) with epinephrine added or potentially substituted when adequate blood pressure cannot be maintained (grade 2B)
• Phenylephrine not recommended except if norepinephrine is associated with serious arrhythmias, if cardiac output is high and blood pressure persistently low, or as salvage therapy when MAP target is not achieved (grade 1C)
• Dobutamine infusion trial up to 20 µg/kg/minute administered or added to vasopressor in the case of myocardial dysfunction or ongoing signs of hypoperfusion (grade 1C)

Corticosteroids

• No corticosteroids in the absence of refractory shock (grade 1D)

Blood Products

• After tissue hypoperfusion is corrected, red blood cell transfusion only when hemoglobin concentration decreases to <7.0 g/dL, to a target hemoglobin concentration of 7.0–9.0 g/dL in adults (grade 1B)

Comment: Severe sepsis and septic shock require rapid identification and initiation of resuscitative measures. These guidelines, although based more on expert consensus than on evidence, should be familiar to all providers who care for patients with severe infections and used to guide initial treatment considerations.

— Kristi L. Koenig, MD, FACEP, FIFEM

Published in Journal Watch Emergency Medicine February 22, 2013