Sepsis Management Guidelines

Immediate Recognition and Initial Actions

The Society of Critical Care Medicine recommends administering IV antimicrobials within 60 minutes of recognizing sepsis or septic shock, as this is the single most important intervention for reducing mortality 1, 2
Obtain at least two sets of blood cultures (aerobic and anaerobic) before antibiotics, but do not delay antimicrobials beyond 45 minutes if cultures cannot be obtained, as recommended by the European Society of Intensive Care Medicine 1, 2, 3
Measure serum lactate as a marker of tissue hypoperfusion, as suggested by the Surviving Sepsis Campaign 2, 3
Administer 30 mL/kg IV crystalloid fluids within the first 3 hours for sepsis-induced hypoperfusion (hypotension or lactate ≥4 mmol/L), as recommended by the Society of Critical Care Medicine 2, 3, 5

The Infectious Diseases Society of America recommends using broad-spectrum therapy covering all likely pathogens (bacterial, fungal, viral) with adequate tissue penetration to the presumed infection source 1, 2, 4
Consider combination therapy (≥2 antibiotics from different classes) for septic shock, particularly for Pseudomonas aeruginosa infections, as suggested by the European Society of Clinical Microbiology and Infectious Diseases 1
Reassess antimicrobial therapy daily for potential narrowing once pathogen identification and sensitivities are available, as recommended by the Society of Critical Care Medicine 1, 2, 3, 4

The Society of Critical Care Medicine recommends targeting mean arterial pressure (MAP) ≥65 mmHg in patients requiring vasopressors 2, 3, 4
Use norepinephrine as first-choice vasopressor, as suggested by the European Society of Intensive Care Medicine 3
Reassess hemodynamic status frequently after initial 30 mL/kg bolus using thorough clinical examination, as recommended by the Society of Critical Care Medicine 2, 5

Implement source control interventions as soon as possible after diagnosis, as recommended by the Infectious Diseases Society of America 3, 4
Drain or debride infected tissues and remove potentially infected foreign bodies/devices, as suggested by the Society of Critical Care Medicine 3
Perform imaging studies promptly to confirm infection source, as recommended by the European Society of Radiology 2, 4

Apply oxygen to achieve saturation >90%, as recommended by the American Thoracic Society 3
Position patients semi-recumbent (head of bed 30-45°) to reduce aspiration risk, as suggested by the Society of Critical Care Medicine 3, 4
Use low tidal volume ventilation (6 mL/kg predicted body weight) for sepsis-induced ARDS, as recommended by the American Thoracic Society 3, 4

Target blood glucose ≤180 mg/dL using protocolized approach, as recommended by the American Diabetes Association 3, 4
Target hemoglobin 7-9 g/dL in absence of tissue hypoperfusion, coronary disease, or acute hemorrhage, as suggested by the Society of Critical Care Medicine 3
Minimize continuous sedation in mechanically ventilated patients, as recommended by the Society of Critical Care Medicine 4

Implement hospital-wide sepsis screening programs for acutely ill, high-risk patients, as recommended by the Society of Critical Care Medicine 2, 3
Establish multidisciplinary teams including physicians, nurses, pharmacy, and respiratory therapy, as suggested by the European Society of Intensive Care Medicine 3
Use sepsis bundles and protocols with regular education and performance feedback, as recommended by the Society of Critical Care Medicine 3

Discuss goals of care and prognosis with patients and families, ideally within 72 hours of ICU admission, as recommended by the Society of Critical Care Medicine 5
Incorporate palliative care principles into treatment planning when appropriate, as suggested by the American Academy of Hospice and Palliative Medicine 5