Summary of New Sepsis Guidelines – JAMA

Guideline title Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Developers Surviving Sepsis Campaign (SSC), Society of Critical Care Medicine (SCCM), and European Society of Intensive Care Medicine (ESICM)

Release date January 18, 2017

Prior versions 2012, 2008, 2004

Target population Adults with sepsis or septic shock

Selected major recommendations

Managing infection:

  • Antibiotics: Administer broad-spectrum intravenous antimicrobials for all likely pathogens within 1 hour after sepsis recognition (strong recommendation; moderate quality of evidence [QOE]).

  • Source control: Obtain anatomic source control as rapidly as is practical (best practice statement [BPS]).

  • Antibiotic stewardship: Assess patients daily for deescalation of antimicrobials; narrow therapy based on cultures and/or clinical improvement (BPS).

Managing resuscitation:

  • Fluids: For patients with sepsis-induced hypoperfusion, provide 30 mL/kg of intravenous crystalloid within 3 hours (strong recommendation; low QOE) with additional fluid based on frequent reassessment (BPS), preferentially using dynamic variables to assess fluid responsiveness (weak recommendation; low QOE).

  • Resuscitation targets: For patients with septic shock requiring vasopressors, target a mean arterial pressure (MAP) of 65 mm Hg (strong recommendation; moderate QOE).

  • Vasopressors: Use norepinephrine as a first-choice vasopressor (strong recommendation; moderate QOE).

Mechanical ventilation in patients with sepsis-related ARDS:

  • Target a tidal volume of 6 mL/kg of predicted body weight (strong recommendation; high QOE) and a plateau pressure of ≤30 cm H2O (strong recommendation; moderate QOE).

Formal improvement programs:

  • Hospitals and health systems should implement programs to improve sepsis care that include sepsis screening (BPS).

– from JAMA 19 Jan 2017

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