Surviving Sepsis Campaign

2021 : Management Sepsis

Mentor :

Oleh :
ROSFI FIRDHA HUZAIMA
Definition (3rd International Consensus
Definitions for Sepsis and Septic Shock)
–“life threatening organ dysfunction caused by a dysregulated host response to
infection”

• Infection: the invasion of normally sterile tissue by organisms resulting in

infectious pathology
• Organ Dysfunction: Increase of 2 or more points in SOFA Score (Sepsis-
related/Sequential Organ Failure Assessment)
SIX SSC ADULT GUIDELINES
WORKING GROUP
SCREENING TOOLS
SCREENING TOOLS
Qsofa Has Limitation

– It relies on the clinician ability to identify infection as the cause of organ

dysfuncion, which may not be apparent early on, making it less sensitive than
SIRS for diagnosing early sepsis.
– Preexisting chronic disease may influence accurate qSofa and SOFA
measurement.
INITIAL RESUSCITATION
INFECTION AND ANTIBIOTIC
TIMING
– For adults with suspected sepsis or septic shock but unconfirmed infection  re-
evaluating and searching for alternative diagnoses and discontinuing empiric
antimicrobials
– For adults with possible septic shock administering antimicrobials immediately,
ideally within 1 hr of recognition and for sepsis without shock administration of
antimicrobials within 3 hr from the time when sepsis was first recognized 
administration of intravenous antimicrobials should be initiated as soon as
possible after recognition and within one hour for both : septic shock and sepsis
INFECTION AND ANTIBIOTIC
TIMING
– For adults with sepsis or septic shock at high risk of MRSA using empiric
antimicrobials with MRSA coverage over using antimicrobials without MRSA
coverage  empiric broad-spectrum therapy with one or more antimicrobials
for patients presenting with sepsis or septic shock to cover all likely pathogens
(including bacterial and potentially fungal or viral coverage.
– For adults with sepsis or septic shock at low risk of MRSA using empiric
antimicrobials with MRSA coverage, as compared with using antimicrobials
without MRSA coverage  empiric broad-spectrum therapy with one or more
antimicrobials
HAEMODYNAMICS
MANAGEMENT
• For adults with septic shock on vasopressors  an
initial target mean arterial pressure (MAP) of 65 
mm Hg over higher MAP targets
•  For adults with sepsis or septic shock, using
balanced crystalloids instead of normal saline for
resuscitation
HAEMODYNAMICS
MANAGEMENT
• septic shock  starting vasopressors peripherally to restore mean arterial
pressure rather than delaying initiation until a central venous access is
secured
• In septic shock, using norepinephrine as the first-line agent over other
vasopressors
• on norepinephrine with inadequate mean arterial pressure levels, adding
vasopressin instead of escalating the dose of norepinephrine
• septic shock and cardiac dysfunction with persistent hypoperfusion despite
adequate volume status and arterial blood pressure, either adding
dobutamine to norepinephrine or using epinephrine alone
ICU ADMISSION
VENTILATION

• sepsis-induced hypoxemic respiratory failure

 use of high flow nasal oxygen over
noninvasive ventilation
• sepsis-induced ARDS  using a low tidal
volume ventilation strategy (6 mL/kg), over a
high tidal volume strategy (> 10 mL/kg)
• sepsis-induced severe ARDS  using an
upper limit goal for plateau pressures of 30 cm
H2O, over higher plateau pressures
ADDITIONAL THERAPIES

– STEROID : against using IV hydrocortisone to treat septic shock patients if

adequate fluid resuscitation and vasopressor therapy are able to restore
hemodynamic stability, If this is not achievable  IV hydrocortisone at a dose
of 200 mg/day
– using low molecular weight heparin over unfractionated heparin for VTE
prophylaxis
– initiating insulin therapy at a glucose level of ≥ 180mg/dL (10 mmol/L)
LONG-TERM OUTCOMES AND
GOALS OF CARE
– discussing goals of care and prognosis with patients and families over no such discussion
– addressing goals of care early (within 72 hr) over late (72 hr or later)
– the principles of palliative care (which may include palliative care consultation based on
clinician judgement) be integrated into the treatment plan, when appropriate, to address
patient and family symptoms and suffering
–  the clinical team provide the opportunity to participate in shared decision making in post-
ICU and hospital discharge planning to ensure discharge plans are acceptable and feasible
– assessment and follow-up for physical, cognitive, and emotional problems after hospital
discharge
TERIMA KASIH