What are the guidelines for managing Sepsis (Systemic Inflammatory Response Syndrome)?

From the Guidelines

Sepsis management guidelines are clear: early recognition and aggressive treatment are crucial.

Key Recommendations

• Early quantitative resuscitation of the septic patient during the first 6 h after recognition is recommended 1
• Blood cultures should be taken before antibiotic therapy, and imaging studies should be performed promptly to confirm a potential source of infection 1
• Administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock and severe sepsis without septic shock is essential 1
• Initial fluid resuscitation with crystalloid is recommended, with consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure 1

Fluid Management

• Initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia should aim to achieve a minimum of 30 mL/kg of crystalloids 1
• Norepinephrine is the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg, with epinephrine added when an additional agent is needed to maintain adequate blood pressure 1

Other Considerations

• Hemoglobin target of 7–9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage is recommended 1
• Avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability is suggested 1 These guidelines are supported by multiple studies, including the Surviving Sepsis Campaign guidelines 1, and are applicable to both resource-rich and resource-poor settings, although implementation may vary depending on the context 1.

From the Research

Guidelines for Managing Sepsis

The management of sepsis involves a combination of early detection, timely source control, prompt antibiotics, aggressive fluid resuscitation, and shock reversal. The following are key guidelines for managing sepsis:

• Early detection and diagnosis using criteria such as qSOFA (quick Sepsis Related Organ Failure Assessment) and SIRS (systemic inflammatory response syndrome) criteria 2
• Timely source control and prompt, appropriate, and correctly dosed antibiotics 3, 4
• Aggressive fluid resuscitation and shock reversal 3, 4
• Repeated bedside assessment to guide management 4

Diagnostic Criteria

The diagnostic criteria for sepsis have evolved over time, with the latest definitions and guidelines published in 2016 and revised in 2021 5. The current criteria include:

• SOFA (Sequential Organ Failure Assessment) score 2
• qSOFA criteria 2
• SIRS criteria 2, 6

Treatment Guidelines

The treatment guidelines for sepsis emphasize the importance of early and appropriate intervention. The following are key components of sepsis treatment:

• Appropriate antimicrobial agents to target the underlying infection 3
• Optimization of intravascular volume to improve stroke volume 3
• Vasopressors to counteract vasoplegic shock 3
• High-quality supportive care 3