Surviving Sepsis

    • Resuscitation
    • Measure serum lactate
    • Obtain blood cultures prior to antibiotic administration
    • Administer broad spectrum antibiotics within:
    •        - 3 hours for ED admissions
    •        - 1 hour for non-ED admissions
    •  
    • In the event of hypotension:
    •        - Deliver a minimum of 20 mL/kg crystalloid
    •        - Apply vasopressors for hypotension not responding to fluid resuscitation. Maintain MAP > 65
    •  
    • In the event of persistent hypotension despite fluid resuscitation
    •        - (septic shock) and/or lactate > 4
    •        - Achieve CVP > 8
    •        - Achieve SvO2 > 65%
    • CVP 8-12 and urine output > 0.5 mL/kg/hr
    •        - Crystalloids or colloids, given as fluid challenges
    •         (1000cc crystalloid or 500cc colloid over 30 min)
    • MAP > 65
    •        - Norepinephrine or dopamine as the initial pressor
    •        - "Physiologic" vasopressin may be added to norepi if poor response
    • SvO2 > 65%
    •        - Transfusion
    •        - Dobutamine (controversial)
    • Administer low dose steroids for septic shock with hypotension that responds poorly to fluids and pressors.
    •        - IV hydrocortisone is the preferred steroid
    •  
    • Administer Xigris (activated drotrecogin alfa) only forpatients with severe sepsis and high risk of death (APACHE II > 25)
    •  
    • Glucose control with a target of <150 mg/dL
    •  
    • Maintain inspiratory plateau pressures < 30 for ventilated patients