Sepsis Management Guidelines

Immediate Recognition and Action

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 critical intervention for reducing mortality 1, 2
Obtain at least two sets of blood cultures before antibiotics, with one drawn percutaneously and one through each vascular access device, but never delay antimicrobials beyond 45 minutes waiting for cultures 1, 2
Measure serum lactate immediately as a marker of tissue hypoperfusion 1, 2
Administer 30 mL/kg IV crystalloid fluids within the first 3 hours for sepsis-induced hypoperfusion 1, 2

The Infectious Diseases Society of America recommends using broad-spectrum empiric therapy covering all likely pathogens with adequate tissue penetration to the presumed infection source 1, 2
Choose one or more drugs active against all likely pathogens based on the presumed source and local resistance patterns 1, 2
Consider combination therapy for septic shock with respiratory failure, particularly for Pseudomonas aeruginosa 1, 2
Use combination therapy for septic shock from bacteremic Streptococcus pneumoniae 1
Consider combination therapy for neutropenic patients and multidrug-resistant pathogens like Acinetobacter 1
Reassess antimicrobial therapy daily for potential narrowing to single-agent therapy once susceptibility profiles are known 1, 2
Limit combination therapy to 3-5 days maximum, then de-escalate 1, 2
Target total duration of 7-10 days for most patients; longer courses may be needed for slow clinical response, undrainable foci, S. aureus bacteremia, fungal/viral infections, or immunodeficiency 1
Use procalcitonin levels to assist in discontinuing empiric antibiotics in patients without subsequent evidence of infection 1

The American College of Critical Care Medicine recommends targeting mean arterial pressure ≥65 mmHg in patients requiring vasopressors 1, 2
After initial 30 mL/kg crystalloid bolus, guide additional fluids by frequent reassessment of hemodynamic status using thorough clinical examination 1, 2
Normalize lactate in patients with elevated levels as a resuscitation endpoint 1

The Society of Critical Care Medicine recommends implementing source control interventions as soon as possible after diagnosis 2, 3
Perform imaging studies promptly to confirm the infection source 1, 2
Drain or debride infected tissues when feasible 2, 3
Remove potentially infected foreign bodies or devices 1, 2

The American Thoracic Society recommends applying oxygen to achieve saturation >90% 2, 3
Position patients semi-recumbent to reduce aspiration risk 2, 3
Use low tidal volume ventilation for sepsis-induced ARDS 2, 3

The Endocrine Society recommends targeting blood glucose ≤180 mg/dL using a protocolized approach 2, 3
Target hemoglobin 7-9 g/dL in the absence of tissue hypoperfusion, coronary disease, or acute hemorrhage 2, 3
Minimize continuous sedation in mechanically ventilated patients 2

The American Society for Parenteral and Enteral Nutrition recommends initiating early enteral feeding rather than complete fasting or IV glucose only in patients who can be fed enterally 4
Use either early trophic/hypocaloric or early full enteral feeding; advance feeds according to patient tolerance if starting with trophic feeding 4
Avoid omega-3 fatty acids as immune supplements 4
Use prokinetic agents for feeding intolerance 4
Place post-pyloric feeding tubes in patients with feeding intolerance or high aspiration risk 4
Avoid IV selenium, arginine, and glutamine supplementation 4

The Joint Commission recommends implementing hospital-wide sepsis screening programs for acutely ill, high-risk patients 1, 2
Establish multidisciplinary teams including physicians, nurses, pharmacy, and respiratory therapy 2, 3
Use sepsis bundles and protocols with regular education and performance feedback 2, 3

The Society of Critical Care Medicine recommends discussing goals of care and prognosis with patients and families, ideally within 72 hours of ICU admission 4, 2
Incorporate palliative care principles into treatment planning when appropriate 4, 2