SURVIVING SEPSIS CAMPAIGN- INTERNATIONAL GUIDELINES FOR MANAGEMENT OF SEPSIS AND SEPTIC SHOCK 2021

1. SURVIVING SEPSIS CAMPAIGN-
INTERNATIONAL GUIDELINES FOR MANAGEMENT OF SEPSIS AND
SEPTIC SHOCK 2021
DR. GUNJAN VYAS
DR.SHEFALI
SMS Medical College & Hospital, Jaipur (RAJ)

2. SEPSIS AND SEPTIC SHOCK

3. SEPSIS BUNDLES

5. WHAT’S NEW AND DIFFERENT- 2021
GUIDELINES

7. SCREENING AND RESUSCITATION
1. SCREENING(NEW)
2. INITIAL FLUID BOLUS( DOWNGRADED STRENGTH)
3. RESUSCITATION TARGETS(NEW)

9. SIRS qSOFA MEWS NEWS
Temperature
Heart rate
BP
RR
sPO2
Supplemental o2 requirement
Mental status
TLC
Urine output

10. Recommendation against- using qSOFA compared to SIRS/NEWS/MEWS as a single screening tool for sepsis or septic
shock
CONCLUSION- Among qSOFA,SIRS AND NEWS- qSOFA showed higher overall
prognostic accuracy than SIRS and NEWS. But lower sensitivity for diagnosis of
sepsis.
Conclusion - qSOFA has lowest sensitivity and is a poor tool for sepsis
screening.

13. For adults with sepsis or septic shock we suggest guiding resuscitation to decrease serum
lactate levels in patients with elevated lactate levels, over not using serum lactate.
Conclusion- lactate clearance - dynamic biomarker indicating that resuscitation strategies are going in right direction.

14. For adult with septic shock we suggest capillary refill time to guide
resuscitation as an adjunct to other measure to perfusion
Conclusion- measurement of Q-CRT may be an alternative for invasive measurement of blood lactate concentration
evaluating patients with suspected sepsis.

15. INFECTION
1. Antimicrobial timing(new/changed)
2. Antimicrobial stopping

19. Caption

20. Stopping Antimicrobials
Caption

21. HEMODYNAMICS
• Fluid type (changed)
• Vasopressor initiation (new)
• Fluid strategy (new)

23. For adults with sepsis or septic shock we suggest using balanced
crystalloids instead of normal saline for resuscitation
Conclusion - use of balanced crystalloids was associated with a lower 30-day- in-
hospital mortality compared with use of saline.
Conclusion-among critically ill patients requiring fluid challlenges use of
balanced solution compared with normal saline solution did not significantly
reduced 90-day mortality

24. For adults with septic shock we suggest starting vasopressor peripherally to restore MAP rather than delaying initiation until a central venous
access is secured. resolution may avoid CVC
rat
Rationale - low complication rate, facilitates faster time to shock resolution, may avoid CVC placement altogether.
Conclusion- reports of administration of vasopressor via PiVC, when given for limited
duration, under close observation, suggest that extravasation in uncommon and is
unlikely to lead to major complication.
Conclusion- published data on tissue injury or extravasation from vasopressor
administration via peripheral IVs are derived mainly from case reports. Further study
is warranted to clarify the safety of vasopressor administration via peripheral IVs.

25. ? There is insufficient evidence to make a recommendation on the use of restrictive
vs liberal fluid strategies in the first 24 hours of resuscitation in patients who still have
signs of hypo-perfusion , volume depletion after initial resuscitation
• 5 pilot RCTs - no signal wide heterogeneity in the definition of conservative vs liberal fluid
approach
• More data soon - CLOVERS trial
CLASSIC trial

28. For adults with sepsis-induced severe ARDS , we suggest using veno-venous ECMO when conventional
mechanical ventilation fails in experienced centres with the infrastructure in place to support its use.
Conclusion- 90- day mortality was significantly lowered by ECMO compared with
conventional management.
Conclusion- compared with conventional mechanical ventilation, use of VV
ECMO in pts with sever ARDS was associated with reduced 60-day mortality.
However there moderate risk of major bleeding.

29. Role of steroids in septic shock.
Caption

30. For adults with sepsis or septic shock we suggest against IV vitamin C
Conclusion- In adults with sepsis receiving vasopressor therapy in ICU those who received IV vitamin C have higher risk of death and persistent organ
dysfunction.

32. LONG TERM OUTCOME

33. THANK YOU