Sepsis Management in Pneumonia

Recognition and Initial Management

The Society of Critical Care Medicine recommends that septic shock be recognized when there is suspected or confirmed infection, and despite full fluid resuscitation, vasopressors are required to maintain a mean arterial pressure (MAP) ≥65 mmHg with lactate ≥2 mmol/L 2, 3, 4
If lactate cannot be measured, consider three manifestations: changes in mental status, oliguria, and poor peripheral perfusion with prolonged capillary refill time 2, 3

The European Society of Intensive Care Medicine recommends administering broad-spectrum intravenous antibiotics within the first hour of septic shock recognition, using empirical combination therapy with at least two different classes of antimicrobials that cover all likely pathogens, including gram-negative and gram-positive bacteria 1
Obtain microbiological cultures (including at least two sets of aerobic and anaerobic blood cultures) before starting antimicrobials, but this should not delay the initiation of antibiotics 1

The Society of Critical Care Medicine recommends administering at least 30 mL/kg of isotonic crystalloids in the first 3 hours in adults 2, 3, 4
Use isotonic crystalloid solutions for resuscitation 2, 3
When septic shock persists after fluid resuscitation, administer norepinephrine as the first-choice vasopressor 2, 3, 4

The European Society of Intensive Care Medicine recommends that combination empirical therapy should not be administered for more than 3-5 days 1, 5
De-escalation to the most appropriate single therapy should be done as soon as the susceptibility profile is known 1, 5
The typical duration of treatment is 7-10 days 1, 5

If pneumonia progresses to acute respiratory distress syndrome (ARDS), adopt conservative fluid management in patients with ARDS without tissue hypoperfusion 2, 3, 4
Avoid routine use of corticosteroids unless there are special reasons 2, 3, 4