Surviving Sepsis Guidelines

An international consensus committee proposed the following guidelines for treatment of septic patients in 2008.  The full guidelines can be viewed at http://www.survivingsepsis.org/

Initial Resuscitation (first 6 hours after diagnosis):

• Begin resuscitation immediately when sepsis is suspected
• Resuscitation goals: CVP 8-12, MAP > 65, UO > 0.5 ml/kg/hr, Mixed venous sat > 70%
• If unable to achieve, consider fluid, pRBC's to keep hematocrit >30%, dobutamine

Diagnosis of infection:

• obtain appropriate cultures prior to starting ATB
• prompt imaging (CXR, CT, etc) as indicated

Antibiotic Therapy:

• begin IV ATB within first hour of diagnosis
• ATB should be broad-specturm
• ATB should be tailored when cx and susceptabilites determined
• duration of 7-10 days

Source identification and control:

• site of infection established within 6 hours
• source control as soon as possible after resuscitation

Fluid Therapy:

• resuscitate with crystalloids or colloids
• target CVP of > 8
• fluid challenges of 1000 ml over 30 minutes

Vasopressors:

• norepinephrine or dopamine are preferred, can add epinephrine if additional pressor is needed
• maintain MAP >65, arterial line is useful
• may add vasopressin at dose of 0.03 units/min

Inotropes:

• dobutamine may be useful in patients with myocardial dysfunction

Steroids:

• consider IV hydrocortisone if pt remains hypotensive
• dose < 300 mg/day

Activated Protein C:

• consider in adult patients with organ dysfunction, high risk of death and no contraindications (bleeding)

Blood Products:

• RBC for Hb < 7.0 with target of 7.0-9.0
• FFP for abnormal INR only if bleeding or planned invasive procedure
• Platelets for <5000 or <30,000 if bleeding

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