Sepsis Management Guidelines

Recognition and Risk Assessment

The Society of Critical Care Medicine recommends using the NEWS2 score to evaluate the risk of severe illness or death from sepsis, with a score ≥7 indicating high risk, 5-6 indicating moderate risk, and considering higher risk regardless of NEWS2 if the patient has specific clinical signs 2
The British Medical Journal suggests monitoring patients according to their risk level, with high-risk patients monitored every 30 minutes, moderate-risk patients every hour, and low-risk patients every 4-6 hours 2

The Society of Critical Care Medicine recommends administering at least 30 mL/kg of IV crystalloid fluid within the first 3 hours for sepsis-induced hypoperfusion, with further fluid administration guided by frequent reassessment of hemodynamic status 1
The American College of Critical Care Medicine suggests targeting a mean arterial pressure of 65 mmHg in patients requiring vasopressors 1
Consider normalizing lactate levels in patients with elevated lactate as a marker of tissue hypoperfusion, as recommended by the Society of Critical Care Medicine 1

The Infectious Diseases Society of America recommends administering IV antimicrobials based on risk level, with high-risk patients receiving antimicrobials within 1 hour, moderate-risk patients within 3 hours, and low-risk patients within 6 hours 2, 1
The Society of Critical Care Medicine suggests obtaining appropriate microbiologic cultures before starting antimicrobial therapy, including at least two sets of blood cultures, and using broad-spectrum therapy to cover all likely pathogens 1
Consider combination therapy for initial management of septic shock, as recommended by the Society of Critical Care Medicine 1

The World Journal of Emergency Surgery recommends considering a higher risk of resistant pathogens if the infection was acquired in a healthcare setting, the patient has been hospitalized for more than 1 week, or has received previous antimicrobial therapy 6
The Society of Critical Care Medicine suggests considering antimicrobials that can be administered as bolus or rapid infusion, such as β-lactams, for patients with limited vascular access 3, 4

The Society of Critical Care Medicine recommends performing daily reassessment of antimicrobial therapy for potential de-escalation once culture results are available, and considering source control within the first 12 hours if feasible [1, 7 is ignored as per instruction to prefer non-Praxis sources]
Perform further hemodynamic assessment, such as cardiac function evaluation, if clinical examination does not lead to a clear diagnosis, as recommended by the Society of Critical Care Medicine 1

The Society of Critical Care Medicine recommends avoiding delays in antimicrobial therapy while waiting for cultures, and ensuring broad-spectrum coverage of all likely pathogens 1, 5
Continue frequent reassessment of fluid status after initial resuscitation, and practice antimicrobial stewardship by narrowing therapy once the pathogen is identified, as recommended by the Society of Critical Care Medicine 1, 3, 4