Surviving Sepsis Campaign

Presenter: Khairul Kamarudin

Supervisor: Dr Lee AV
Definition
• “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 S.O.F.A Score

(Sepsis-related/Sequential Organ Failure Assessment)
 Sofa Score with Mortality Rate

- Sofa score does not define sepsis

- But presence of infection with 2 or more sofa score criteria is a predictor of increased mortality rate
and icu stay >3days.
- Benefit:
a. does not require lab test
b. can be asses quickly and rapidly
1 hour bundle
1. Measure lactate level:
• Represent / marker of tissue hypoperfusion
• If initial lactate >2 mmol/L , Remeasured within 2-4 hours.
• Measure at the beginning and post resuscitation until normalize

2. Blood Cultures:
• At least 2 sets(aerobic and anaerobic) before starting antibiotics,
or not more than 45 minutes of therapy.
• 2 samples:
- One from percutaneous access
- One from previously(>48 hours) inserted vascular
access device
3. Administer broad spectrum antibiotics

- Should be started within 1st hour of recognition of sepsis or septic shock

- Empiric antibiotic therapy should be narrow once pathogen

identified and sensitivity known.

- Procalcitonin levels can be use to deescalate or discontinuation of empiric antibiotics in

patients who initially appeared septic.

- Emperic combination therapy should not be administered for >3-5 days and must be de-escalation
to appropriate single therapy.

- Duration of therapy: 7-10 days (longer for slower response)

- Given appropriate to patient source of infection:

a. Sepsis from pulmonary source
b. Sepsis from CRBSI
c. Sepsis from urinary source
d. Sepsis from unknown source
Source Control
• Source of infection should be diagnosed or excluded as early as
possible (< 12 hours)

• eg: intra-abdominal abscess / pelvic abscess

• Drainage (Percutaneous) of abscess

• Remove IV access devices if found as possible source of infection

4. Administer IV Fluids
• Crystalloid 30 ml/kg to be completed within 3 hours of recognition.

• Goal is to reach target MAP (≥ 65 mm Hg )

• Albumin: (if no improvement of haemodynamic status)

- Used in fluid refractory septic shock and if >0.2 mcg/kg/min of Norad is required

- Dose: 100-200ml of 20% Human Albumin within 30-60 minutes

5. Vasopressors:
• Urgent restoration of an adequate perfusion pressure to the vital organs.
• Should be commenced in 1st hour if MAP is not ≥ 65 mm Hg after fluid resuscitation

• Noradrenaline ( 1 st Choice)

• Adrenaline: when additional agent is needed with intent to raise map to target

• Vasopressin 0.03 units-0.04 units/min:

- Added to NE with intent of either raising MAP or decrease
Norad dose (Salvage Therapy)
• Dopamine:
- alternative to Norad only in selected patients
- Patients with low risk of tachycardia or absolute relative bradycardia

• Dobutamine: Upto 20 mcg/kg/min in presence of:

- Myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output
- Ongoing signs of hypoperfusion, despite achieving adequate intravascular
volume and adequate MAP.
Steroid Therapy

• NOT recommended to treat septic shock if fluids or vasopressors can

maintain MAP (Hemodynamic stability).

• If haemodynamic stability not achievable in spite of fluids, and

require escalating doses of vasopressor, only then we use iv.
Hydrocortisone 200 mg/day.
Initial Resuscitation Goals within first 6
hours
• CVP : 8-12 mm Hg
• MAP : ≥ 65 mm Hg
• Urine Output : ≥ 0.5 ml/kg/hr
• Central Venous (SVC) or Mixed Venous Oxygen Saturation 70% or 65%
respectively
• In patients with elevated lactate, target to decrease lactate