Management of Sepsis

Initial Resuscitation

The American College of Critical Care Medicine recommends administering 30 mL/kg crystalloid bolus within the first hour of sepsis diagnosis, with a target mean arterial pressure ≥65 mmHg 1, 2
The Surviving Sepsis Campaign suggests starting broad-spectrum antibiotics within the first hour of documented hypotension, with each hour of delay decreasing survival by 7.6% 1, 2
Initial empiric antibiotic regimen should include meropenem, imipenem/cilastatin, or piperacillin/tazobactam as monotherapy, according to the Infectious Diseases Society of America 1

The Society of Critical Care Medicine recommends targeting mean arterial pressure ≥65 mmHg as the initial goal, with norepinephrine as the first-line vasopressor 1, 2, 3
Norepinephrine can be started peripherally while awaiting central venous access, with a dose range of 0.02-0.1 mcg/kg/min 1, 2, 3
The American Heart Association suggests that norepinephrine is superior to dopamine and causes less tachycardia and arrhythmias 1

The World Journal of Emergency Surgery recommends obtaining blood cultures before antibiotic administration, but not delaying antibiotics for culture results 2, 4, 5, 6
Essential laboratory tests include complete blood count with differential, serum electrolytes, C-reactive protein, procalcitonin, serum lactate levels, renal and liver function tests, serum albumin, and blood gas analysis, according to the Society of Critical Care Medicine 2, 4
Serum lactate >2 mmol/L confirms septic shock and requires repeat measurement within 6 hours to assess lactate clearance, as recommended by the Surviving Sepsis Campaign 2, 3

The Society of Critical Care Medicine suggests monitoring for improvement in MAP, urine output, lactate clearance, mental status, and skin perfusion every 15-30 minutes during initial resuscitation 1, 2, 3
Repeat lactate within 6 hours if initially elevated to assess adequacy of resuscitation, as recommended by the Surviving Sepsis Campaign 2, 3
The American College of Critical Care Medicine recommends avoiding dopamine as first-line therapy, as it is associated with higher mortality and more arrhythmias compared to norepinephrine 3