Sepsis Management Guidelines

Initial Assessment and Recognition

The American College of Critical Care Medicine recommends implementing routine screening of potentially infected seriously ill patients to increase early identification of sepsis 2
Obtain at least two sets of blood cultures before starting antimicrobial therapy, as long as this doesn't delay treatment >45 minutes, as suggested by the Praxis Medical Insights 1
Measure serum lactate levels as a marker of tissue hypoperfusion, according to the Praxis Medical Insights 1
Perform thorough clinical examination and use imaging techniques when available to identify the source of infection, as recommended by the Intensive Care Medicine journal 3

Administer intravenous antimicrobials within one hour of recognizing sepsis, as recommended by the Intensive Care Medicine journal 4
Target adequate tissue perfusion as the principal endpoint of resuscitation, according to the Intensive Care Medicine journal 3
Administer crystalloid fluids at 30 mL/kg for initial resuscitation in patients with sepsis-induced hypoperfusion, as suggested by the Praxis Medical Insights 1

Target a mean arterial pressure (MAP) ≥65 mmHg in patients requiring vasopressors, according to the Praxis Medical Insights 1
Use norepinephrine as the first-choice vasopressor, as recommended by the Praxis Medical Insights 1
Administer intravenous hydrocortisone (up to 300 mg/day) or prednisolone (up to 75 mg/day) to adult patients requiring escalating dosages of vasopressors, as suggested by the Intensive Care Medicine journal 3

Implement source control interventions as soon as possible after diagnosis, according to the Praxis Medical Insights 1
Drain or debride the source of infection whenever possible, as recommended by the Intensive Care Medicine journal 3
Remove any foreign body or device that may potentially be the source of infection, as suggested by the Intensive Care Medicine journal 3

Apply oxygen to achieve an oxygen saturation >90%, as recommended by the Intensive Care Medicine journal 3
Place patients in a semi-recumbent position (head of the bed raised to 30–45°), according to the Intensive Care Medicine journal 3
Use low tidal volume ventilation (6 mL/kg predicted body weight) for patients with sepsis-induced ARDS, as suggested by the Intensive Care Medicine journal 5

Reassess antimicrobial therapy daily for potential de-escalation once culture results are available, according to the Praxis Medical Insights 6
Target hemoglobin of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage, as recommended by the Intensive Care Medicine journal 5
Maintain blood glucose ≤180 mg/dL using a protocolized approach, as suggested by the Praxis Medical Insights 1

Establish a multidisciplinary team including physicians, nurses, pharmacy, respiratory therapy, and administration, as recommended by the Critical Care Medicine journal 2
Ensure collaboration between medicine, surgery, and emergency medicine specialties, according to the Critical Care Medicine journal 2
Implement sepsis bundles and protocols with regular education and performance feedback, as suggested by the Critical Care Medicine journal 2