Sepsis Management Recommendations

Initial Resuscitation

The Surviving Sepsis Campaign recommends administering at least 30 mL/kg of IV crystalloid fluid within the first 3 hours for patients with sepsis-induced hypoperfusion 3, 1, 2
The Society of Critical Care Medicine suggests using crystalloids as the fluid of choice for initial resuscitation—either balanced crystalloids or saline 3
The European Society of Intensive Care Medicine recommends avoiding hydroxyethyl starches completely due to increased risk of acute kidney injury and mortality 3, 4
Consider adding albumin when patients require substantial amounts of crystalloids to maintain adequate mean arterial pressure, as recommended by the Intensive Care Medicine journal 3

The American College of Emergency Physicians recommends administering IV broad-spectrum antimicrobials within 1 hour of recognizing sepsis or septic shock 1, 2
Each hour of delay in antimicrobial administration is associated with a 7.6% average decrease in survival, according to the Annals of Oncology 5
Obtain at least two sets of blood cultures (aerobic and anaerobic) before starting antibiotics, but do not delay antibiotics more than 45 minutes to obtain cultures, as recommended by the Surviving Sepsis Campaign 1

The American Heart Association recommends targeting mean arterial pressure (MAP) ≥65 mmHg in patients requiring vasopressors 1, 2, 4
The Society of Critical Care Medicine suggests using norepinephrine as the first-choice vasopressor for persistent hypotension despite adequate fluid resuscitation 1, 2, 4
Add epinephrine when an additional agent is needed to maintain adequate blood pressure, as recommended by the Critical Care Medicine journal 2, 4

The Infectious Diseases Society of America recommends identifying or excluding a specific anatomic diagnosis of infection requiring emergent source control as rapidly as possible 3, 1, 2
Implement required source control intervention (drainage, debridement) within 12 hours after diagnosis is made, as soon as medically and logistically practical, as recommended by the Intensive Care Medicine journal 3, 1

The Infectious Diseases Society of America recommends reassessing antimicrobial therapy daily for de-escalation once pathogen identification and sensitivities are established 7, 3, 1
Plan to narrow antimicrobial therapy once adequate clinical improvement is noted, as recommended by the Surviving Sepsis Campaign 1
Typical duration of antibiotic therapy is 7-10 days; shorter courses are appropriate for rapid clinical resolution following effective source control, according to the Intensive Care Medicine journal 7