surviving sepsis campaign

1. Society of Critical Care Medicine &
European Society of Intensive Care
Medicine
Surviving Sepsis Campaign: International Guidelines for
Management of Sepsis and Septic Shock 2021
The Surviving Sepsis Campaign Bundle: 2018 Update
Surviving Sepsis
Campaign

3. WHAT IS SEPSIS ?
•Define SEPSIS ?
•Septic shock ?

4. Sepsis
caused by
• Life threatening organ dysfunction
dysregulated host response to infection

5. Septic shock ?
• Subset of sepsis with :
• Circulatory & Cellular / metabolic dysfunction
Associated with higher risk of mortality
• Can be clinically identified by
- to maintain a mean arterial pressure of 65 mm Hg or
greater
- serum lactate level greater than 2 mmol/L (>18 mg/dL)
in the absence of hypovolemia
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

6. • We recommend against using qSOFA compared
with SIRS, NEWS, or MEWS as a single screening
tool for sepsis or septic shock.
Strong recommendation, moderate-quality evidence.

7. (Quick Sequential Organ Failure Assessment)
(REMEMBER ---- HAT)
1) Hypotensive (systolic ≤ 100)
2) Altered conscious level (GCS <15)
3) Tachypnea Respiratory rate ≥ 22
• 2 out of 3 criteria = SEPSIS
• predicted mortality of ≥10%
• > specific
qSOFA

8. SIRS
(Systemic inflammatory response syndrome)
• 2 out of 4 criteria = SEPSIS

10. • Sepsis & septic shock are medical emergencies &
we recommend that treatment & resuscitation
begin immediately.

11. Surviving Sepsis Campaign :
• Recommendation for initial resuscitation :
• At least 30 mL/kg of IV crystalloid fluid should be given within the first 3 hours of
resuscitation. (balanced crystalloids instead of normal saline for resuscitation.)
• Guiding resuscitation to decrease serum lactate in patients with elevated lactate
level.
• Adults with septic shock, use capillary refill time to guide resuscitation as an
adjunct to other measures of perfusion
• Use dynamic measures to guide fluid resuscitation over physical examination or
static parameters alone.
-passive leg raise or a fluid bolus
-stroke volume (SV), stroke volume variation (SVV), pulse pressure variation
(PPV), or echocardiography, where available.

14. Initial resuscitation
• Septic 1 hour bundle :
• Measure lactate level. Re – measure if initial lactate is > 2 mmol/L
• Obtain blood cultures prior to administration of antibiotics
• Administer broad spectrum antibiotics
• Begin rapid administration of 30 ml / kg crystalloid for hypotension or
if lactate > 4 mmol/L (withinthefirst 3 hours)
• Apply vasopressors if patient is hypotension during or after fluid
resuscitation to maintain MAP > 65 mm Hg
• Additional fluids be guided by frequent reassessment of
haemodynamic status

15. Source control
• We recommend that a specific diagnosis of infection requiring emergent
source control be identified or excluded rapidly
• To obtain culture
• Antibiotics
• We recommend that administration of IV antimicrobials be initiated as soon as
possible after recognition & within 1 hour for both sepsis & septic shock
• We recommend empiric broad spectrum therapy with one or more antimicrobials to
cover all likely pathogens
• Antibiotics Stewardship

16. Antibiotics Stewardship
• Do not start antibiotics when there is no evidence of infection
• Narrowed the antibiotics once pathogen identification & sensitivities are
established
• Antimicrobial duration of 7 – 10 days is adequate for most serious infection

17. Fluid therapy
• Crystalloids :
• as the fluid of choice for initial resuscitation
• balanced crystalloids instead of normal saline for resuscitation
• Subsequent intravascular volume replacement in patients with sepsis & septic
shock
• Using albumin in addition to crystalloids when patient require substantial amounts
of crystalloid
• Aim MAP of > 65 mm Hg in patients with septic shock requiring vasopressors

18. Vasoactive agents
• Noradrenaline as the 1st choice
• Intent of raising MAP to the target value
• If shock is not resolving quickly ……..
• Further haemodynamic assessment (such as assessing cardiac
function)
• To determine the type of shock if the clinical examination does not
lead to a clear diagnosis

20. Lactate ???
• Can help to guide resuscitation
• Marker of tissue hypoperfusion
• Suggest guiding resuscitation to normalize lactate levels
• Aim <2.0mmol /L