Sepsis Management Guidelines

Initial Assessment and Diagnosis

The Society of Critical Care Medicine recommends obtaining at least two sets of blood cultures before starting antimicrobial therapy, as long as this doesn't delay treatment >45 minutes 2, 3
Measure serum lactate levels as a marker of tissue hypoperfusion, as recommended by the European Society of Intensive Care Medicine 4, 5
Consider 1,3-β-D-glucan assay, mannan, and anti-mannan antibody assays if invasive candidiasis is suspected, according to the Infectious Diseases Society of America 2, 5

The European Society of Intensive Care Medicine recommends administering IV antimicrobials within one hour of sepsis recognition, using broad-spectrum antibiotics that cover all likely pathogens 1, 2, 3
Use broad-spectrum antibiotics that cover all likely pathogens, as recommended by the American Thoracic Society 1, 6
For septic shock, use combination therapy with at least two antibiotics of different antimicrobial classes targeting the most likely bacterial pathogens, according to the Society of Critical Care Medicine 1, 3

The Society of Critical Care Medicine recommends administering crystalloid fluids at 30 mL/kg for initial resuscitation in patients with sepsis-induced hypoperfusion 8, 3
Target a mean arterial pressure (MAP) ≥65 mmHg in patients requiring vasopressors, as recommended by the European Society of Intensive Care Medicine 4, 3
Norepinephrine is the first-choice vasopressor, according to the American College of Cardiology 8, 4

Implement source control interventions as soon as possible after diagnosis, as recommended by the Infectious Diseases Society of America 2, 6
Remove intravascular access devices confirmed to be the source of sepsis after establishing alternative vascular access, according to the Society of Healthcare Epidemiology of America 7

Target hemoglobin of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage, as recommended by the American College of Chest Physicians 8, 4
Use low tidal volume ventilation (6 mL/kg predicted body weight) for patients with sepsis-induced ARDS, according to the American Thoracic Society 8, 4
Maintain blood glucose ≤180 mg/dL using a protocolized approach, as recommended by the American Diabetes Association 8, 3