Sepsis

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Surviving Sepsis Campaign Bundle

https://www.sccm.org/SurvivingSepsisCampaign/Guidelines/Adult-Patients

TO BE COMPLETED WITHIN 3 HOURS:

1. Measure lactate level
2. Obtain blood cultures prior to administration of antibiotics
3. Administer broad spectrum antibiotics
4. Administer 30ml/kg crystalloid for hypotension or lactate ≥4mmolL

 

TO BE COMPLETED WITHIN 6 HOURS:

5. Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a MAP ≥65mm Hg
6. In the event of a persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥4mmol/L:
   1. Measure central venous pressure (CVP)
   2. Measure central venous oxygen saturation (ScvO₂)
7. Remeasure lactate if initial lactate was elevated*

*Target for quantitative resuscitation included in the guidelines is CVP of ≥8mm Hg, ScvO_{2 ≥}70%, and normalize lactate

DOCUMENT REASSESSMENT OF VOLUME STATUS AND TISSUE PERFUSION WITH:

EITHER

• Repeat focused exam (after initial fluid resuscitation) by licensed independent practitioner including vital signs, cardiopulmonary, capillary refill, pulse, and skin findings.

OR TWO OF THE FOLLOWING:

• Measure CVP
• Measure ScvO2
• Bedside cardiovascular ultrasound
• Dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge

Definitions

Septic Shock Refractory to Fluid Resuscitation:

1. Initiate norepinephrine infusion
2. Supplement calcium, ionized calcium target 1.2 – 1.3
3. Add vasopressin 0.04 units per minute infusion
4. Evaluate cardiac function by echo (TTE or TEE,) consider EDM or PA catheter, check ScvO_2,
5. Add steroids – hydrocortisone continuous infusion – 8.3 mg per hour via continuous infusion (200mg over 24 hours)
6. Add epinephrine continuous infusion