International Guidelines for

Management of Sepsis and

Septic Shock 2021
 INTRODUCTION
• Sepsis is one of the oldest and most exclusive syndromes
in medicine.
• Sepsis was often described as “Blood Poisoning.”
• It is the leading cause of death
• The word “sepsis” was used in Greek literature and is
derived from the Greek work “sepo,” which translates to
“I rot”.
 DEFINITIONS :
• Sepsis exists on a continuum of severity ranging
from infection and bacteremia to sepsis and
septic shock, which can lead to multiple organ
dysfunction syndrome (MODS) and death.

• The definitions of sepsis and septic shock have

rapidly evolved since the early 1990s .

• The systemic inflammatory response syndrome

(SIRS) is no longer included in the definition
since it is not always caused by infection.
 DEFINITIONS :
• Systemic inflammatory response syndrome (SIRS): It
is an inflammatory response state affecting the whole
body. It’s the body response to infectious and non
infectious insult.
• SIRS criteria are present in many hospitalized
patients who do not develop infection, and their
ability to predict death is poor when compared with
other scores such as the SOFA score .
`
• It is a form of dysregulated inflammation. It was
previously defined as two or more abnormalities in
Temp, HR, respiration, or WBC .

• SIRS may occur in several conditions related, or not, to

infection. Noninfectious conditions classically associated
with SIRS include autoimmune disorders, pancreatitis,
vasculitis, thromboembolism, burns or surgeries .
 First International Consensus
Definitions for Sepsis and Septic
Shock (1991)
• In the 1991 definitions (reviewed in 2001) sepsis is defined as a
systemic inflammatory response to a new infection, and severe
sepsis is defined as sepsis associated with organ dysfunction,
hypoperfusion, or hypotension.

• Sepsis with hypoperfusion is defined by the presence of acute

circulatory failure: arterial hypotension (SBP <90 mmHg, reduced
by >40 mmHg from baseline or [MAP] of <65 mmHg), or other
evidence of hypoperfusion, such as serum lactate >2 mmol/L (>18
mg/dL).

• Septic shock is defined as being present when hypoperfusion

persists for at least 1 hour despite adequate fluid resuscitation
and is unexplained by other causes.
 Third International Consensus
Definitions for Sepsis and Septic Shock
(Sepsis-3) 2016
• Sepsis has been redefined as life-threatening organ
dysfunction caused by a dysregulated host response
to a new infection.

• Septic shock has also been redefined as a subset of

sepsis in which particularly profound circulatory,
cellular, and metabolic abnormalities are associated
with a greater risk of mortality than with sepsis
alone.
• SIRS : Generalized inflammatory response of the body
to a variety of clinical conditions including infection, but
not limited to infection.
• Systemic inflammatory response syndrome (SIRS):
Two or more of the following conditions:
(1) fever (oral temperature >38°C) or hypothermia
(<36°C)
(2) tachypnoea (>20 breaths/min)
(3) tachycardia (heart rate >90 beats/min)
(4) leucocytosis (>12,000/ml), leucopoenia
(<4,000/ml), or >10% bands
 SEPTIC SHOCK
• Definition :A subset of sepsis in which underlying circulatory and
cellular /metabolic abnormalities lead to substantially increased
mortality risk
• Clinical Features
Signs of infection plus altered mental status, oliguria cool peripheries,
hyperlactemia plus vasopressor therapy needed to maintain MAP >/=
65 mm of hg and serum lactate > 2 m.mol/l despite adequate fluid
resuscitation
Spectrum of sepsis syndrome
• Sepsis ( Severe sepsis) : Systemic response to proven or
suspected infection and some degree of organ
hypoperfusion that is-

CVS
Renal
SBP < 90mmHg Respiratory
Urine output <
MAP < 70mmHg 0.5ml/kg/hr for 1 hr PaO2/FiO2 <250

Hematologic
Platelet count <80,000 Unexplained
50% decrease from metabolic acidosis
highest value
• Septic shock : Sepsis with hypotension for atleast 1 hr
despite fluid resuscitation
OR
Need for vasopressors to maintain SBP >90mmHg or
MAP >70mmHg
• Refractory septic shock : Septic shock that lasts for >1hr
and does not respond to fluid or pressor administration.

• MODS : Presence of altered organ function lasting for

>24hrs in an acutely ill patient, such that homeostasis
cannot be maintained without intervention.
• Primary MODS – It occurs due to of a well defined
insult in which organ dysfunction occurs early and can
be directly attributable to the insult itself.
Eg. Acute renal failure due to Rhabdomyolysis.

• Secondary MODS – Organ failure not in direct response

to the insult itself, but is a consequence of the host’s
response.
Eg. ARDS in pancreatitis.
Table of Current Recommendations and
Changes From Previous 2016 Recommendations
Recommendations 2021 Changes From 2016 Recommendations
1. For hospitals and health systems, we recommend We recommend that hospitals and hospital systems
using a performance improvement program for sepsis, have a performance improvement pro- gram for sepsis
including sepsis screening for acutely ill, high-risk including sepsis screening for acutely ill, high-risk
patients and standard operating procedures for patients.”
treatment.
2. We recommend against using qSOFA compared with NEW
SIRS, NEWS, or MEWS as a single- screening tool for
sepsis or septic shock
3. For adults suspected of having sepsis, we suggest
measuring blood lactate.
Recommendations 2021 Changes From 2016 Recommendation
4. Sepsis and septic shock are medical emergencies,
and we recommend that treatment and resuscitation
begin immediately.
5. For patients with sepsis induced hypoperfusion or We recommend that in the initial resuscitation from
septic shock we suggest that at least 30 mL/ kg of IV sepsis-induced hypoperfusion, at least 30mL/kg of IV
crystalloid crystalloid fluid be given within the first 3 hr”
fluid should be given within the first 3 hr of resus-
citation.
6. For adults with sepsis or septic shock, we suggest
using dynamic measures to guide fluid resuscitation,
over physical examination, or static parameters alone.
Recommendations 2021 Changes From 2016 Recommendation
7. For adults with sepsis or septic shock, we suggest
guiding resuscitation to decrease serum lactate in
patients with elevated lactate level, over not using
serum lactate.
8. For adults with septic shock, we suggest using
capillary refill time to guide resuscitation as an adjunct
to other measures of perfusion.
• The guidelines recommend that hospitals use a performance
improvement program for sepsis, including screening of high-risk
patients and standard operating procedures for management.
• The guidelines recognize sepsis as a medical emergency and
recommend that treatment and resuscitation begin immediately.
• For initial resuscitation in patients with sepsis-induced hypoperfusion
or septic shock, the guidelines suggest 30 mL/kg IV crystalloid. This
recommendation was downgraded from a strong recommendation to
a weak recommendation based on the low quality of evidence.
•
• Additionally, the guidelines suggest resuscitation be guided by
dynamic over static measures, target a decrease in serum lactate, and
use capillary refill as an adjunct measure of perfusion.
• New to this update, the guidelines recommend against qSOFA as a
sole screening tool and suggest that patients who are determined to
need intensive care be admitted to an ICU within 6 hours.
MEAN ARTERIAL PRESSURE
Recommendations 2021
9. For adults with septic shock on vasopressors, we
recommend
an initial target mean arterial pressure (MAP) of
65mm Hg
over higher MAP targets.
ADMISSION TO INTENSIVE CARE
Recommendations 2021

10. For adults with sepsis or septic shock who re- quire
ICU admission, we suggest admitting the patients to
the ICU within 6 hr.
INFECTION
Recommendations 2021

11. For adults with suspected sepsis or septic shock

but unconfirmed infection, we recom-mend
continuously re-evaluating and searching for
alternative diagnoses and discontinuing empiric
antimicrobials if an alternative cause of illness is
demonstrated or strongly suspected.
12. For adults with possible septic shock or a high CHANGED from previous:
likelihood for sepsis, we recommend adminis- tering “We recommend that administra- tion of intravenous
antimicrobials immediately, ideally within 1 hr of antimicrobials should be initiated as soon as pos- sible
recognition. after recognition and within one hour for both a)
septic shock and b) sepsis without shock”
13. For adults with possible sepsis without shock, we
recommend rapid assessment of the likeli- hood of
infectious versus noninfectious causes of acute illness.
Recommendations 2021
14. For adults with possible sepsis without shock, we
suggest a time-limited course of rapid inves- tigation
and if concern for infection persists, the
administration of antimicrobials within 3 hr from the
time when sepsis was first recognized.
15. For adults with a low likelihood of infection and
without shock, we suggest deferring anti- microbials
while continuing to closely monitor the patient.
16. For adults with suspected sepsis or septic shock,
we suggest against using procalcitonin plus clin- ical
evaluation to decide when to start antimicrobi- als, as
compared to clinical evaluation alone.
NEW from previous:
“We recommend that administration of IV
antimicrobials should be initiated as soon as possible
after recogni- tion and within 1hr for both a) septic
shock and b) sepsis without shock”
NEW from previous:
“We recommend that administration of IV
antimicrobials should be initiated as soon as possible
after recogni- tion and within 1hr for both a) septic
shock and b) sepsis without shock“
Recommendations 2021
17. For adults with sepsis or septic shock at high risk of
MRSA, we recommend using empiric antimicrobials
with MRSA coverage over using antimicrobials without
MRSA coverage.
18. For adults with sepsis or septic shock at low risk of
MRSA, we suggest against using em- piric
antimicrobials with MRSA coverage, as compared with
using antimicrobials without MRSA coverage.
NEW from previous:
“We recommend 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.”
NEW from previous:
“We recommend 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.”
Recommendations 2021
19. For adults with sepsis or septic shock and high risk
for multidrug resistant (MDR) organ- isms, we suggest
using two antimicrobials with gram-negative coverage
for empiric treatment over one gram-negative agent.
20. For adults with sepsis or septic shock and low risk
for multidrug resistant (MDR) organisms, we suggest
against using two gram-negative agents for empiric
treatment, as compared to one gram-negative agent.
21. For adults with sepsis or septic shock, we suggest
against using double gram-negative coverage once the
causative pathogen and the susceptibilities are known.
Recommendations 2021
22. For adults with sepsis or septic shock at high risk of NEW from previous:
fungal infection, we suggest using empiric antifungal “We recommend empiric broad-spectrum therapy
therapy over no antifungal therapy. with one or more antimicrobials for patients
presenting with sepsis or septic shock to cover all
likely pathogens (including bac- terial and potentially
fungal or viral coverage.”
23. For adults with sepsis or septic shock at low risk of NEW from previous:
fungal infection, we suggest against em- piric use of “We recommend empiric broad-spectrum therapy
antifungal 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. “
24. We make no recommendation on the use of
antiviral agents
Recommendations 2021
25. For adults with sepsis or septic shock, we sug- gest
using prolonged infusion of beta-lactams for
maintenance (after an initial bolus) over conventional
bolus infusion.
26. For adults with sepsis or septic shock, we
recommend optimising dosing strategies of
antimicrobials based on accepted pharmaco-
kinetic/pharmacodynamic (PK/PD) principles and
specific drug properties.
27. For adults with sepsis or septic shock, we
recommend rapidly identifying or excluding a specific
anatomical diagnosis of infection that requires
emergent source control and imple- menting any
required source control intervention as soon as
medically and logistically practical.
Recommendations 2021
28. For adults with sepsis or septic shock, we
recommend prompt removal of intravascular access
devices that are a possible source of sepsis or septic
shock after other vascular access has been
established.
29. For adults with sepsis or septic shock, we sug- gest
daily assessment for de-escalation of anti- microbials
over using fixed durations of therapy without daily
reassessment for de-escalation.
30. For adults with an initial diagnosis of sepsis or
septic shock and adequate source control, we suggest
using shorter over longer duration of antimicrobial
therapy.
Recommendations 2021
31. For adults with an initial diagnosis of sepsis or
septic shock and adequate source control where
optimal duration of therapy is unclear, we suggest
using procalcitonin AND clinical evaluation to decide
when to discontinue antimicrobials over clinical
evaluation alone
• As in the 2016 guidelines, the 2021 guidelines again recommend
delivering antimicrobials as soon as possible, ideally within 1 hour of
sepsis recognition.
• The guidelines now stratify antimicrobial timing recommendations
based on the likelihood of sepsis and presence of shock .
• For patients with probable sepsis or with shock resulting from
possible or probable sepsis, the guidelines recommend administering
antimicrobials immediately, ideally within 1 hour of recognition.
• For patients with possible sepsis but without shock, the guidelines
recommend rapid assessment of the likelihood of infection versus
non-infectious illness.
• If concern for infection persists after a time-limited course of rapid
investigation, then antimicrobials should be administered within 3
hours from when sepsis was first recognized.
• Finally, for patients with a low likelihood of infection and without
shock, the guidelines suggest deferring antimicrobials while
continuing to closely monitor the patient.
HEMODYNAMIC MANAGEMENT
Recommendations 2021
32. For adults with sepsis or septic shock, we rec-
ommend using crystalloids as first-line fluid for
resuscitation.
33. For adults with sepsis or septic shock, we suggest CHANGED from weak recommendation, low quality of
using balanced crystalloids instead of normal saline for evidence.
resuscitation. “We suggest using either bal- anced crystalloids or
saline for fluid resuscitation of patients with sepsis or
septic shock”
34. For adults with sepsis or septic shock, we sug- gest
using albumin in patients who received large volumes
of crystalloids.
Recommendations 2021
35. For adults with sepsis or septic shock,
we recommend against using starches for
resuscitation.
36. For adults with sepsis and septic shock, we suggest “We suggest using crystalloids over gelatins when
against using gelatin for resuscitation. resuscitat- ing patients with sepsis or septic shock.”
37. For adults with septic shock, we recommend using
norepinephrine as the first-line agent over other
vasopressors.
38. For adults with septic shock on norepinephrine
with inadequate mean arterial pressure levels, we
suggest adding vasopressin instead of escalating the
dose of norepinephrine.
Recommendations 2021
39. For adults with septic shock and inadequate mean
arterial pressure levels despite norepi- nephrine and
vasopressin, we suggest adding epinephrine.
40. For adults with septic shock, we suggest against
using terlipressin
41. For adults with septic shock and cardiac dys-
function with persistent hypoperfusion despite
adequate volume status and arterial blood pressure,
we suggest either adding dobuta- mine to
norepinephrine or using epinephrine alone.
42. For adults with septic shock and cardiac dys- NEW
function with persistent hypoperfusion despite
adequate volume status and arterial blood pres- sure,
we suggest against using levosimendan.
Recommendations 2021
43. For adults with septic shock, we suggest invasive
monitoring of arterial blood pressure over noninvasive
monitoring, as soon as practical and if resources are
available.
44. For adults with septic shock, we suggest starting NEW
vasopressors peripherally to restore mean arterial
pressure rather than delaying initiation until a central
venous access is secured.
45. There is insufficient evidence to make a NEW
recommendation on the use of restrictive versus “We suggest using either bal- anced crystalloids or
liberal fluid strategies in the first 24 hr of resuscitation saline for fluid resuscitation of patients with sepsis or
in patients with sepsis and septic shock who still have septic shock”
signs of hypoperfusion and volume depletion after the Weak recommendation, low quality of evidence
initial resusci- tation. “We suggest using crystalloids over gelatins when
resuscitat- ing patients with sepsis or septic shock.”
Weak recommendation, low quality of evidence
• The guidelines recommend crystalloid fluids as a first line for
resuscitation, and new in this update, suggest balanced crystalloids over
normal saline.
• For patients with septic shock, the guidelines recommend
norepinephrine as the first-line vasopressor and suggest that
vasopressors be started peripherally to avoid delays in administration in
the absence of central venous access.
• There was insufficient evidence to make a recommendation regarding
the use of a restrictive versus liberal fluid strategy after the initial fluid
resuscitation, and this remains an important area for future research. As
in the 2016 guidelines, albumin is suggested in patients who have
received large volumes of crystalloid.
VENTILATION
Recommendations 2021
46.There is insufficient evidence to make a recom-
mendation on the use of conservative oxygen targets
in adults with sepsis-induced hypox- emic respiratory
failure.
47. For adults with sepsis-induced hypoxemic res- NEW
piratory failure, we suggest the use of high flow nasal
oxygen over noninvasive ventilation
48. There is insufficient evidence to make a recom-
mendation on the use of noninvasive ventila- tion in
comparison to invasive ventilation for adults with
sepsis-induced hypoxemic respira- tory failure.
Recommendations 2021
49. For adults with sepsis-induced ARDS, we rec-
ommend using a low tidal volume ventilation strategy
(6 mL/kg), over a high tidal volume strategy (> 10
mL/kg).

50. For adults with sepsis-induced severe ARDS, we

recommend using an upper limit goal for plateau
pressures of 30 cm H2O, over higher plateau
pressures.

51. For adults with moderate to severe sepsis- induced

ARDS, we suggest using higher PEEP over lower PEEP.
Recommendations 2021
52. For adults with sepsis-induced respiratory failure
(without ARDS), we suggest using low tidal volume as
compared with high tidal volume ventilation.

53. For adults with sepsis-induced moderate- severe

ARDS, we suggest using traditional recruitment
maneuvers.

54. When using recruitment maneuvers, we rec-

ommend against using incremental PEEP
titration/strategy.
Recommendations 2021
55. For adults with sepsis-induced moderate- severe
ARDS, we recommend using prone ventilation for
greater than 12 hr daily.

56. For adults with sepsis induced moderate- severe

ARDS, we suggest using intermittent NMBA boluses,
over NMBA continuous infusion.

57. For adults with sepsis-induced severe ARDS, we NEW

suggest using Veno-venous (VV) ECMO when
conventional mechanical ventilation fails in
experienced centers with the infrastructure in place to
support its use.
• The guidelines recommend a low tidal volume ventilation strategy
with limitation of plateau pressure for patients with sepsis-associated
ARDS and the use of prone positioning in moderate-to-severe ARDS,
and suggest a low tidal volume approach for all patients with sepsis-
induced respiratory failure.
• The guidelines suggest using traditional recruitment maneuvers but
recommend against an incremental PEEP strategy. There was
insufficient evidence to make a recommendation regarding use of
liberal versus conservative oxygen targets; this remains an important
area for future research.
ADDITIONAL THERAPIES
58. For adults with septic shock and an ongoing
requirement for vasopressor therapy we sug- gest
using IV corticosteroids.
59. For adults with sepsis or septic shock we sug- gest
against using polymyxin B hemoperfusion.
60. There is insufficient evidence to make a recom-
mendation on the use of other blood purifica- tion
techniques.
“We suggest against using IV hydrocortisone to treat
septic shock patients if adequate fluid resuscitation
and vasopressor therapy are able to restore he-
modynamic stability (see goals for Initial
Resuscitation). If this is not achievable, we suggest IV
hydrocortisone at a dose of 200 mg/day.”
NEW from previous:
“We make no recommendation regarding the use of
blood purification techniques”
61. For adults with sepsis or septic shock we
recommend using a restrictive (over liberal)
transfusion strategy.

62. For adults with sepsis or septic shock we suggest

against using IV immunoglobulins.

63. For adults with sepsis or septic shock, and who

have risk factors for gastrointestinal (GI) bleeding, we
suggest using stress ulcer pro- phylaxis.
Recommendations 2021 Changes From 2016 Recommendations
64. For adults with sepsis or septic shock, we
recommend using pharmacologic venous
thromboembolism (VTE) prophylaxis unless a
contraindication to such therapy exists.

65. For adults with sepsis or septic shock, we rec-

ommend using low molecular weight heparin over
unfractionated heparin for VTE prophy- laxis

66. For adults with sepsis or septic shock, we suggest

against using mechanical VTE prophy- laxis, in addition
to pharmacological prophy- laxis, over pharmacologic
prophylaxis alone.
Recommendations 2021 Changes From 2016 Recommendations
67. In adults with sepsis or septic shock and AKI, we
suggest using either continuous or intermit- tent renal
replacement therapy.

68. In adults with sepsis or septic shock and AKI, with

no definitive indications for renal replace- ment
therapy, we suggest against using renal replacement
therapy.

69. For adults with sepsis or septic shock, we rec-

ommend initiating insulin therapy at a glucose level of
≥ 180mg/dL (10 mmol/L).
Recommendations 2021 Changes From 2016 Recommendations
70. For adults with sepsis or septic shock we suggest
against using IV vitamin C.

71. For adults with septic shock and hypoper- fusion-

induced lactic acidemia, we suggest against using
sodium bicarbonate therapy to improve
hemodynamics or to reduce vaso- pressor
requirements.

72. For adults with septic shock and severe metabolic

acidemia (pH ≤ 7.2) and acute kidney injury (AKIN
score 2 or 3), we suggest using sodium bicarbonate
therapy
Recommendations 2021 Changes From 2016 Recommendations
73. For adult patients with sepsis or septic shock who
can be fed enterally, we suggest early (within 72 hr)
initiation of enteral nutrition.
• To limit overlap with other guidelines and create space for a new
section focused on long-term outcomes, PICOs on additional
therapies were reduced from prior SSC guidelines.
• However, there are some noteworthy new recommendations
regarding adjunctive therapies. In contrast to the 2016 guidelines, the
2021 guidelines suggest the use of IV corticosteroids for patients with
an ongoing need for vasopressor therapy based on newer clinical trial
data.
• Additionally, the guidelines suggest against using IV vitamin C for
sepsis or septic shock based on recent randomized controlled trials
and an updated meta-analysis showing no impact on mortality.
LONG-TERM OUTCOMES AND GOALS OF CARE

Recommendations 2021 Changes From 2016 Recommendations

74. For adults with sepsis or septic shock,

we recommend discussing goals of care and prognosis
with patients and families over no such discussion.

75. For adults with sepsis or septic shock, we suggest

addressing goals of care early (within 72 hr) over late
(72 hr or later).

76. For adults with sepsis or septic shock, there is

insufficient evidence to make a recommenda- tion on
any specific standardized criterion to trigger goals of
care discussion.
Recommendations 2021 Changes From 2016 Recommendations

77. For adults with sepsis or septic shock, we rec-

ommend that the principles of palliative care (which
may include palliative care
consultation based on clinician judgement) be
integrated into the treatment plan, when appro-
priate, to address patient and family symptoms and
suffering.

78. For adults with sepsis or septic shock, we suggest

against routine formal palliative care consultation for
all patients over palliative care consultation based on
clinician judgement.
Recommendations 2021 Changes From 2016 Recommendations

79. For adult survivors of sepsis or septic shock and

their families, we suggest referral to peer support
groups over no such referral

80. For adults with sepsis or septic shock, we suggest

using a handoff process of critically important
information at transitions of care over no such handoff
process.

81. For adults with sepsis or septic shock, there is

insufficient evidence to make a recommen- dation on
the use of any specific structured handoff tool over
usual handoff processes.
Recommendations 2021 Changes From 2016 Recommendations

82. For adults with sepsis or septic shock and their

families, we recommend screening for ec- onomic and
social support (including housing, nutritional,
financial, and spiritual support), and make referrals
where available to meet
these needs.

83. For adults with sepsis or septic shock and their

families, we suggest offering written and verbal sepsis
education (diagnosis, treatment, and post-ICU/post-
sepsis syndrome) prior to hospital discharge and in the
follow-up setting.
Recommendations 2021 Changes From 2016 Recommendations

84. For adults with sepsis or septic shock and their

families, we recommend the clinical team provide the
opportunity to participate in shared decision making
in post-ICU and hospital dis- charge planning to ensure
discharge plans are acceptable and feasible.

85. For adults with sepsis and septic shock and their
families, we suggest using a critical care transition
program, compared with usual care, upon transfer to
the floor.
Recommendations 2021 Changes From 2016 Recommendations

86. For adults with sepsis and septic shock, we

recommend reconciling medications at both ICU and
hospital discharge.

87. For adult survivors of sepsis and septic shock and

their families, we recommend including information
about the ICU stay, sepsis and related diagnoses,
treatments, and common impairments after sepsis in
the written and verbal hospital discharge summary.
Recommendations 2021 Changes From 2016 Recommendations

88. For adults with sepsis or septic shock who

developed new impairments, we recommend hospital
discharge plans include follow-up with clinicians able
to support and manage new and long-term sequelae.

89. For adults with sepsis or septic shock and their

families, there is insufficient evidence to make a
recommendation on early post- hospital discharge
follow-up compared with routine post-hospital
discharge follow-up.

90. For adults with sepsis or septic shock, there is

insufficient evidence to make a recom- mendation for
or against early cognitive therapy.
Recommendations 2021 Changes From 2016 Recommendations

91. For adult survivors of sepsis or septic shock, we

recommend assessment and follow-up for physical,
cognitive, and emotional problems after hospital
discharge.

92. For adult survivors of sepsis or septic shock, we

suggest referral to a post-critical illness follow-up
program if available.

93. For adult survivors of sepsis or septic shock

receiving mechanical ventilation
for > 48hr or an ICU stay of > 72hr, we suggest referral
to a post-hospital rehabili- tation program.
As acute survival from sepsis has improved, the 2017 World Health
Organization resolution on sepsis called for improving outcomes of sepsis
survivors and addressing survivors’ access to rehabilitation .
Given the burden of long-term morbidity and mortality stemming from
sepsis, the SSC guidelines now include a section dedicated to the longer-
term recovery from sepsis. To enhance recovery, the guidelines
recommend screening for economic and social support for patient and
families, involving patients and families in shared decision-making
regarding discharge planning, reconciling medications at both ICU and
hospital discharge, including information about sepsis and common
impairment after sepsis in the discharge summary, and assessing for
physical, cognitive, and emotional problems after hospital discharge.
.
• The guidelines suggest having a critical care transitional program
during ICU stay to floor transitions, using a handoff process during
transitions of care, offering verbal and written sepsis education, and
referring patients to peer support programs, post-critical illness
follow-up programs (if available), and post-hospital rehabilitation
programs (for selected survivors).
• There was insufficient evidence to make a recommendation regarding
early cognitive rehabilitation or timing of post-hospital follow up.
While many of these recommendations are generally applicable to
critically ill and hospitalized patients, the panel deemed them
necessary to include in the sepsis guidelines given the burden of long-
term morbidity and mortality due to sepsis
THANKYOU