Surviving Sepsis

Campaign
Society of Critical Care Medicine &
European Society of Intensive Care
Medicine
Surviving Sepsis Campaign: International Guidelines for
Management of Sepsis and Septic Shock 2021

The Surviving Sepsis Campaign Bundle: 2018 Update

 WHAT IS
SEPSIS ?
• Define SEPSIS
?
• Septic shock ?
 Sepsis
• Life threatening organ caused
dysfunction dysregulated host by
response to infection
 Septic shock ?
• Subset of sepsis with :
• Circulatory & Cellular / metabolic dysfunction
Associated with higher risk ofmortality
• Can be clinically identified by
- to maintain a mean arterial pressure of 65 mm Hg or
greater
- serum lactate level greater than 2 mmol/L (>18 mg/dL)
in the absence of hypovolemia
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
• We recommend against using qSOFA compared with
SIRS, NEWS, or MEWS as a single screening tool
for sepsis or septic shock.

Strong recommendation, moderate-quality evidence.

 qSOFA
(Quick Sequential Organ Failure Assessment)

(REMEMBER ---- HAT)

1) Hypotensive (systolic ≤ 100)
2) Altered conscious level (GCS <15)
3) Tachypnea Respiratory rate ≥ 22

• 2 out of 3 criteria = SEPSIS

• predicted mortality of ≥10%
• > specific
 SIRS
(Systemic inflammatory response syndrome)

• 2 out of 4 criteria = SEPSIS

• Sepsis & septic shock are medical emergencies
& we recommend that treatment &
resuscitation begin immediately.
Surviving Sepsis Campaign :
• Recommendation for initial resuscitation :
• At least 30 mL/kg of IV crystalloid fluid should be given within the first 3 hours of
resuscitation. (balanced crystalloids instead of normal saline for resuscitation.)
• Guiding resuscitation to decrease serum lactate in patients with elevated lactate
level.
• Adults with septic shock, use capillary refill time to guide resuscitation as an
adjunct to other measures of perfusion
• Use dynamic measures to guide fluid resuscitation over physical examination
or static parameters alone.
-passive leg raise or a fluid bolus
-stroke volume (SV), stroke volume variation (SVV), pulse pressure variation
(PPV), or echocardiography, where available.
 Initial resuscitation

• Septic 1 hour bundle :

• Measure lactate level. Re – measure if initial lactate is > 2 mmol/L
• Obtain blood cultures prior to administration of antibiotics
• Administer broad spectrum antibiotics
• Begin rapid administration of 30 ml / kg crystalloid for hypotension or
if lactate > 4 mmol/L (within the first 3 hours)
• Apply vasopressors if patient is hypotension during or after fluid
resuscitation to maintain MAP > 65 mm Hg
• Additional fluids be guided by frequent reassessment of
haemodynamic status
 Source control
• We recommend that a specific diagnosis of infection requiring emergent
source control be identified or excluded rapidly
• To obtain culture

• Antibiotics
• We recommend that administration of IV antimicrobials be initiated as soon as
possible after recognition & within 1 hour for both sepsis & septic shock
• We recommend empiric broad spectrum therapy with one or more antimicrobials
to cover all likely pathogens
• Antibiotics Stewardship
Antibiotics Stewardship

• Do not start antibiotics when there is no evidence of infection

• Narrowed the antibiotics once pathogen identification & sensitivities
are established
• Antimicrobial duration of 7 – 10 days is adequate for most serious
infection
 Fluid therapy
• Crystalloids :
• as the fluid of choice for initial resuscitation
• balanced crystalloids instead of normal saline for resuscitation
• Subsequent intravascular volume replacement in patients with sepsis & septic
shock
• Using albumin in addition to crystalloids when patient require substantial amounts
of crystalloid
• Aim MAP of > 65 mm Hg in patients with septic shock requiring vasopressors
 Vasoactive agents

• Noradrenaline as the 1st choice

• Intent of raising MAP to the target value

• If shock is not resolving quickly ……..

• Further haemodynamic assessment (such as assessing cardiac
function)
• To determine the type of shock if the clinical examination does not
lead to a clear diagnosis
 Lactate ???

• Can help to guide resuscitation

• Marker of tissue hypoperfusion
• Suggest guiding resuscitation to normalize lactate
levels
• Aim <2.0mmol /L