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Sepsis: Sepsis 3, Surviving Sepsis Campaign what now?
23 GenFrom a practical clinical point of view, after the 2016 update of the SSC (Surviving Sepsis Campaign) guidelines we have two references when comes to deal with a potential septic patient.
2016 Sepsis 3 definition and early management.
2016 Surviving Sepsis Campaign
Let’s see how to treat, based on top evidences, a real patient in the the pre-hospital and emergency department time window.
But, first of all, the definitions:
Definitions
Both the guidelines now agree that:
“Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection“
“Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) despite adequate volume resuscitation”
Early identification
Early management
Take home points for early phase management
Early Identification
Use either:
qSOFA (preferred in ED) cut off ≥2 points
PSS (preferred in the field) cut off ≥2 points.
Initial Management (target to a MAP >65)
Emodynamic stabilisation
1st Fluid 30 ml/Kg of crystalloids.
2nd Norepinephrine up to 35-90 μg/min (if 1st step failed).
Add Epinephrine up to 20-50 μg/min to achieve MAP target (if first 2 step failed).
Take blood cultures (if feasible before antibiotics but without delaying antibiotics).
Do not delay early broad spectrum antibiotic mono therapy.
References
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Tag:Guidelines, Sepsis, Sepsis 3, Surviving Sepsis Campaign