Sepsis Management Recommendations

Initial Resuscitation

The Society of Critical Care Medicine recommends administering at least 30 mL/kg of IV crystalloid fluid within the first 3 hours of recognition of sepsis-induced hypoperfusion 2, 1, 3
The American College of Critical Care Medicine suggests using crystalloids as the primary resuscitation fluid, with consideration of albumin in patients requiring substantial ongoing crystalloid to maintain adequate mean arterial pressure 3
The Critical Care Medicine journal recommends avoiding hetastarch formulations entirely 3
The Intensive Care Medicine journal suggests continuing fluid challenges as long as hemodynamic improvement occurs, guided by frequent reassessment using dynamic variables 2, 1, 3

The Society of Critical Care Medicine recommends targeting mean arterial pressure ≥65 mmHg in patients requiring vasopressors 2, 1, 3
The American College of Critical Care Medicine suggests using norepinephrine as the first-choice vasopressor to maintain this target 3
The Critical Care Medicine journal recommends adding epinephrine when an additional agent is needed to maintain adequate blood pressure 3
The Intensive Care Medicine journal suggests using vasopressin (0.03 U/min) to raise MAP to target or decrease norepinephrine dose, but not as the initial vasopressor 3

The Infectious Diseases Society of America recommends administering IV antimicrobials within 1 hour of recognition for both sepsis and septic shock 2, 1
The Society of Critical Care Medicine suggests obtaining at least two sets of blood cultures (aerobic and anaerobic) before starting antimicrobials, provided this causes no substantial delay (>45 minutes) 2, 1
The American College of Critical Care Medicine recommends using empiric broad-spectrum therapy with one or more antimicrobials covering all likely pathogens (bacterial, and potentially fungal or viral) 2, 1
The Critical Care Medicine journal suggests reassessing antimicrobial regimen daily for potential de-escalation 2, 5

The Society of Critical Care Medicine recommends identifying anatomical diagnosis of infection requiring source control as rapidly as possible 5
The American College of Critical Care Medicine suggests undertaking intervention for source control within 12 hours after diagnosis is made, if feasible 5
The Critical Care Medicine journal recommends using the effective intervention with least physiologic insult (e.g., percutaneous rather than surgical drainage of abscess) 5

The American College of Critical Care Medicine recommends targeting hemoglobin of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage 3
The Critical Care Medicine journal suggests using low tidal volume ventilation 3
The Society of Critical Care Medicine recommends implementing recruitment maneuvers in patients with severe refractory hypoxemia due to ARDS 6
The American College of Critical Care Medicine suggests considering prone positioning in sepsis-induced ARDS patients with PaO₂/FiO₂ ratio ≤100 mmHg in facilities with experience 6