Sepsis Update 5

5. Sepsis Series: Surviving Sepsis Campaign

Surviving Sepsis Campaign is a collaborative effort by the European Society of Intensive Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine in combating Sepsis. (survivingsepsis.org/)

Periodically, it updates guidelines on management, diagnosis, and treatment of sepsis. Some of the approaches are as follows:

• For brief summary, click here at guideline.gov:
• For complete summary, click here (pdf)
  

1. Antibiotics: given on the first hour. Take appropriate culture first but should not prevent prompt administration of antimicrobial therapy.
2. Fluids: no preference on either crystalloid or colloid. Target is CVP of 8 except when patient is on mechanical ventilation where target is 12.
3. Steroids: only if BP is non responsive to fluids and vasopressors. ACTH stimulation test is not recommended to identify target patients. (some institutions do it however)
4. Bloods: packed RBC if Hb is below 7 g/dL to target 7-9 g/dL; platelets given if below 5k or if below 30k but with significant risk of bleeding.
5. Insulin: given if glucose is >150 mg/dL (8 mmol/L)
   
6. Airway: semi-recumbent 30-45 degrees, ventilated if ALI/ARDS (tidal volume 6 mL/kg)
7. Renal replacement: indications for severe sepsis and ARF are the same.
8. Sodium Bicarbonate, not given if pH is >7.15
9. DVT Prophylaxis: severe sepsis given UFH or LMWH unless contraindicated
10. Stress Ulcer Prophylaxis (SUP): either H2 blocker or PPI
    
11. Activated Protein C (APC, Xigris): indication

• APACHE >25 or Multiorgan Failure
• Review Contraindications and Warning (mostly related to risk of bleeding)

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survivingsepsis.org/