Sepsis Management Guidelines

Diagnosis and Screening

The Society of Critical Care Medicine recommends that sepsis be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, with an acute increase in Sequential Organ Failure Assessment (SOFA) score of ≥2 points, correlating with in-hospital mortality >10% 1, 2, 3
The World Journal of Emergency Surgery guidelines state that the term "severe sepsis" is now obsolete and should not be used, and SIRS criteria are no longer required for sepsis diagnosis 1, 3
The American College of Critical Care Medicine suggests using the Quick SOFA (qSOFA) score as a bedside screening tool to identify patients with suspected infection at high risk for poor outcomes, with a score ≥2 indicating high-risk patients requiring immediate full SOFA assessment and consideration for ICU-level care 1, 2, 3, 4

The Surviving Sepsis Campaign recommends administering broad-spectrum intravenous antibiotics within the first hour of recognition, with a Grade 1B recommendation for septic shock and Grade 1C for sepsis without shock 5, 3
The World Journal of Emergency Surgery guidelines suggest initiating aggressive fluid resuscitation with crystalloid solutions, targeting initial hemodynamic resuscitation within 3 hours, and starting vasopressor therapy if hypotension persists after initial fluid challenge 2, 6
The Society of Critical Care Medicine recommends calculating serial SOFA scores every 48-72 hours to track organ dysfunction trajectory, with worsening scores indicating poor prognosis and need for intervention escalation 3

The World Journal of Emergency Surgery guidelines state that octogenarians and nonagenarians may present with fewer signs of peritonitis and attenuated inflammatory response, making diagnosis more challenging 1
The World Journal of Emergency Surgery guidelines also suggest that HIV-infected patients have increased sepsis risk due to immune system dysfunction, with relatively poorer outcomes even on antiretroviral therapy 1

The Intensive Care Medicine guidelines recommend targeting tidal volume of 6 mL/kg predicted body weight, with plateau pressures ≤30 cm H2O, and applying PEEP to avoid alveolar collapse 6, 7

The Intensive Care Medicine guidelines suggest transfusing RBCs only when hemoglobin <7.0 g/dL, targeting 7.0-9.0 g/dL once tissue hypoperfusion resolved, and not using antithrombin 6, 7

The Intensive Care Medicine guidelines recommend not administering corticosteroids for sepsis in the absence of shock, and using continuous infusion of hydrocortisone when given in septic shock 6