What are the main pillars of sepsis (Systemic Inflammatory Response Syndrome) and septic shock treatment?

From the Guidelines

The main pillars of sepsis and septic shock treatment focus on early recognition and rapid intervention, with administration of broad-spectrum antibiotics within one hour of recognition and prompt fluid resuscitation with crystalloids, followed by vasopressors if necessary, as recommended by the Surviving Sepsis Campaign guidelines 1. The initial management includes:

• Immediate administration of broad-spectrum antibiotics within one hour of recognition, with common regimens including combinations like vancomycin plus piperacillin-tazobactam or meropenem, adjusted based on suspected source and local resistance patterns, as suggested by the guidelines 1.
• Fluid resuscitation should begin promptly with crystalloids (typically 30 ml/kg within the first 3 hours), as recommended by the guidelines 1.
• Vasopressors, such as norepinephrine, should be used if hypotension persists despite fluids, with a target mean arterial pressure of at least 65 mmHg, as recommended by the guidelines 1.
• Source control is essential, including drainage of abscesses or removal of infected devices within 6-12 hours when possible.
• Ongoing management requires close monitoring of lactate clearance, hemodynamic parameters, and organ function, with supportive care including mechanical ventilation if needed, glycemic control targeting blood glucose of 140-180 mg/dL, and venous thromboembolism prophylaxis. These interventions work together to restore tissue perfusion, control infection, and prevent further organ dysfunction, significantly improving survival rates when implemented promptly as part of a coordinated care approach, as emphasized by the guidelines 1.

From the Research

Main Pillars of Sepsis and Septic Shock Treatment

The main pillars of sepsis and septic shock treatment include:

• Early recognition and diagnosis of sepsis and septic shock 2, 3, 4, 5, 6
• Early goal-directed resuscitation of the septic patient during the first 6 hours after recognition 2
• Appropriate diagnostic studies to ascertain causative organisms before starting antibiotics 2
• Early administration of broad-spectrum antibiotic therapy 2, 3, 4, 6
• Reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate 2

Resuscitation and Vasopressor Therapy

Resuscitation and vasopressor therapy are critical components of sepsis and septic shock treatment, including:

• Aggressive fluid challenge to restore mean circulating filling pressure 2
• Vasopressor preference for norepinephrine and dopamine 2, 3, 5
• Cautious use of vasopressin pending further studies 2, 3
• Consideration of dobutamine inotropic therapy in some clinical situations 2

Supportive Care and Organ Dysfunction

Supportive care and management of organ dysfunction are also essential, including:

• Stress-dose steroid therapy for septic shock 2, 3, 4
• Use of recombinant activated protein C in patients with severe sepsis and high risk for death 2
• Maintenance of blood glucose <150 mg/dL after initial stabilization 2
• Low tidal volume and limitation of inspiratory plateau pressure strategy for acute lung injury and acute respiratory distress syndrome 2, 6
• Application of a minimal amount of positive end-expiratory pressure in acute lung injury/acute respiratory distress syndrome 2