Sepsis Management Guidelines

General Recommendations

The Surviving Sepsis Campaign recommends implementing the core components of the 1-hour bundle, including early recognition, immediate antibiotics, fluid resuscitation, and source control, while adapting to local resource constraints 1, 2
Measure serum lactate levels as a marker of tissue hypoperfusion, and remeasure within 2-4 hours if initially elevated 1, 2
Obtain at least two sets of blood cultures before starting antimicrobials, as long as this doesn't delay treatment >45 minutes 1, 2
Administer intravenous broad-spectrum antimicrobials within one hour of recognizing sepsis or septic shock 1, 2, 3
Begin rapid fluid resuscitation with 30 mL/kg of crystalloid for hypotension or lactate ≥4 mmol/L 1, 2
Start vasopressors if patient remains hypotensive despite adequate fluid resuscitation, targeting mean arterial pressure (MAP) ≥65 mmHg 1, 2

Use norepinephrine as the first-choice vasopressor to maintain MAP ≥65 mmHg 1, 3
Add epinephrine when an additional agent is needed to maintain adequate blood pressure 1, 3
Consider vasopressin (0.03 U/min or 0.01-0.04 units/min) as rescue therapy in refractory shock 1, 3
Monitor urine output (target ≥0.5 mL/kg/hr), lactate levels, and clinical signs of perfusion 1

Apply oxygen to achieve oxygen saturation >90% 1, 3
Position patients semi-recumbent (head of bed elevated 30-45°) 1, 3
Use low tidal volume ventilation (6 mL/kg predicted body weight) for sepsis-induced ARDS 1, 3

In malaria-endemic areas, give parenteral antibiotics in addition to antimalarial treatment for patients with slide-proven malaria presenting with severe clinical syndromes 7
In Dengue shock syndrome, consider colloid solutions for fluid resuscitation in children 1
In tuberculosis, initiate combination therapy with isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampicin for 4 months 7
In HIV/AIDS, use trimethoprim/sulfamethoxazole for 3 weeks for Pneumocystis jiroveci pneumonia, with prednisolone added for hypoxemia 7

Each hour of delay in antibiotic administration is associated with a 7.6% decrease in survival—never delay beyond one hour 3
Failure to identify and control the infection source leads to persistent sepsis 3
Overlooking daily antimicrobial reassessment contributes to antimicrobial resistance 3
Excessive fluid administration without frequent reassessment can cause fluid overload 1, 2
Leaving septic patients unattended—ensure continuous observation and clinical examinations several times per day 1