Sepsis

Question 1

Define sepsis

Answer 1

Life-threatening organ dysfunction caused by dysregulated host response to infection

Question 2

Define Septic shock

Answer 2

Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with higher risk of mortality

Sepsis and septic shock are medical emergencies and we recommend that treatment and resuscitation begin immediately.

Question 3

Outline the 2012 Recommendation for management of sepsis - Goals of Initial resuscitation

Answer 3

a) CVP 8–12 mm Hg
b) MAP ≥ 65 mm Hg
c) Urine output ≥ 0.5 mL/kg/hr
d) Scvo2 ≥ 70%.

Question 4

SEPSIS RED FLAGS

Answer 4

• Responds only to voice or pain / unresponsive
• Acute confusional state
• Systolic B.P ≤ 90 mmHg (or drop > 40 from normal)
• Heart rate > 130 per minute
• Respiratory rate ≥ 25 per minute
• Needs oxygen to keep SpO2 ≥ 92%
• Non-blanching rash, mottled / ashen / cyanotic
• Not passed urine in last 18 h / UO <0.5 ml / kg / hr
• Lactate ≥ 2 mmol / l
• Recent chemotherapy

Question 5

What does a Sepsis Chart include?

Answer 5

• 1.OXYGEN: Titrate O2 Sats to 94 -98% /88-92% COPD.
• 2. CULTURES: Take blood cultures before antimicrobials. • 3. FLUIDS - Isotonic
• 4.BLOODS - Lactate
• 5.ANTIMICROBIALS – Trust Guidelines
• 6. URINE OUTPUT – Hourly

Question 6

In confirmed sepsis when should antimicrobials be started?

Answer 6

• We recommend that administration of IV antimicrobials be initiated as soon as possible after recognition and within 1 h for both sepsis and septic shock.
(strong recommendation, moderate quality of evidence).
• We recommend empiric broad-spectrum therapy with one or more antimicrobials to cover all likely pathogens.
(strong recommendation, moderate quality of evidence).

Question 7

In confirmed sepsis how much fluids should be given? What kind of fluids?

Answer 7

• We recommend that in the resuscitation from sepsis-induced hypoperfusion, at least 30ml/kg of intravenous crystalloid fluid be given within the first 3 hours.
(Strong recommendation; low quality of evidence)
• We recommend that following initial fluid resuscitation, additional fluids be guided by frequent reassessment of hemodynamic status.
(Best Practice Statement)
• We recommend crystalloids as the fluid of choice for initial resuscitation and subsequent intravascular volume replacement in patients with sepsis and septic shock
(Strong recommendation, moderate quality of evidence).
• We suggest using albumin in addition to crystalloids when patients require substantial amounts of crystalloids
(weak recommendation, low quality of evidence).

Question 8

What is the initial MAP target in a patient with sepsis?

Answer 8

We recommend an initial target mean arterial pressure of 65 mmHg in patients with septic shock requiring vasopressors. (Strong recommendation; moderate quality of evidence)

Question 9

Surviving Sepsis Summary

Answer 9

• Start resuscitation early with source control, intravenous fluids and antibiotics.
• Frequent assessment of the patients’ volume status is crucial throughout the resuscitation period.
• We suggest guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion.