SHM's Clinical Quick Talks-Sepsis Syndrome

Pdf Summary

This document discusses sepsis syndromes and provides guidance on managing a patient with sepsis. Sepsis is identified by the presence of two systemic inflammatory response syndrome (SIRS) criteria along with a source of infection. The criteria include abnormal temperature, heart rate, respiratory rate, and white blood cell count. Severe sepsis is defined as sepsis with new end organ dysfunction. Septic shock is characterized by persistent arterial hypotension despite volume resuscitation.<br /><br />The sepsis bundle, which should be completed within three hours, includes administering fluids for hypotension or elevated lactate levels, measuring lactate level, obtaining blood cultures before antibiotics, and administering broad-spectrum antibiotics. The antibiotics should be reassessed daily for potential de-escalation, and de-escalation to the most appropriate single therapy should occur as soon as susceptibility profile is known. The duration of therapy is typically 7-10 days.<br /><br />Within six hours, vasopressors should be applied if hypotension does not respond to fluid resuscitation, and lactate should be remeasured if initially elevated. Goals during the first six hours of resuscitation include achieving a central venous pressure of 8-12 mm Hg, a mean arterial pressure of 65 mm Hg, and a urine output of 0.5 mL/kg/hr. Central venous or mixed venous oxygen saturation should be 70% or 65% respectively.<br /><br />Source control is crucial in managing sepsis and should be performed promptly with imaging. The least physiologically harmful intervention should be used when source control is required. Intravascular devices that are potential sources of infection should be promptly removed after obtaining alternative vascular access.<br /><br />The document emphasizes the importance of early recognition of sepsis syndromes for timely implementation of sepsis bundles and reduction in mortality. Fluid resuscitation should be guided by targeted endpoints such as blood pressure, urine output, lactate levels, and central venous pressure. Prompt antimicrobial therapy and source control are essential. Appropriate triage and consideration of escalating the level of care are also important factors to consider in managing sepsis.

Asset Subtitle

Nazish Ilyas

Keywords

sepsis syndromes

managing sepsis

systemic inflammatory response syndrome

severe sepsis

septic shock

sepsis bundle

fluid resuscitation

source control

antimicrobial therapy

mortality reduction