Sepsis Pearls for 2019
The Surviving Sepsis Campaign has decided to do away with the previous 3 hour and 6 hour bundles and come up with a new 1 hour bundle for Sepsis Management.
Goal for within the 1st Hours of Sepsis Management
1. Measure a lactate level (plan to repeat the lactate if greater than 2 mmol)
2. Obtain blood cultures and urine cultures
3. Administer broad spectrum antibiotics
4. Rapid administration of 30 mL/Kg of Ringer's Lactate for MAP < 65 or a Lactate > 4 mmol
5. If Map < 65 mmHG during or after fluid resuscitation start norepinephrine
Now keep in mind that there is some controversy regarding this “one size fits all approach” and a number of associations such as the American College of Emergency Physicians and the Society of Critical Care Medicine expressed concern over the new guidelines.
Ringers Lactate is probably your GO-TO fluid for Resuscitation of the critically ill patient as per the SMART trial. Semler, et al. NEJM 2018
To Steroid or Not to Steroid…That is the Question. Likely no mortality benefit but may result in improvement of other outcomes (i.e. ventilator free days). Consider in ventilated vasopressor dependent shock. Rygard et al 2018
Balanced Crystalloids versus Saline in Critically Ill Semler et. Al. N Engl J Med 2018; 378:829-839
Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis. Rygard et al Intensive Care Med. 2018 Jul;44(7):1003-1016.