INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 INITIAL RESUSCITATION

1. Treatment and resuscitation begun immediately

2. If sepsis-induced hypoperfusion
Give at least 30mL/kg of IV crystalloid fluid within

first 3 hours.
3. Do frequent and further hemodynamic assessment
(ex. assess cardiac function).
4. For Px req. vasopressors
Initial target MAP = 65mmHg
5. Normalize lactate in Px w/ elevated lactate levels.
 INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 SCREEN FOR SEPSIS
&PERFORMANCE IMPROVEMENT

1. Hospitals and hospital systems should have a

performance improvement program for sepsis,
incl. sepsis screening for acutely ill, high risk
patients.
 INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 DIAGNOSIS

1. Do appropriate routine microbiologic cultures

before antimicrobial therapy

** Always include at least 2 sets of blood cultures

(aerobic and anaerobic).
 INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 ANTIMICROBIAL THERAPY

1. IV antimicrobials initiated ASAP after recognition

and within 1hour
2. Use empiric broad-spectrum therapy w/ 1 or more
antimicrobials
3. Narrow down therapy once pathogen ID and
sensitivities established
4. Not recommended Use for sustained systemic
antimicrobial prophylaxis in Px w/ severe
inflammatory states of noninfectious origin
 ANTIMICROBIAL THERAPY

5. DOSING optimize based on accepted

pharmacokinetic/pharmacodynamic principles and
drug properties
 ANTIMICROBIAL THERAPY

6. COMBINATION THERAPY
Empiric combo therapy (at least 2 antibiotics of
diff antimicrobial classes)
Routine use for ongoing treatment of most other
serious infections is not recommended
Combo therapy for treatment of neutropenic
sepsis/bacteremia is not recommended
IF used De-escalation w/ discontinuation of
combination therapy within first few days in
response to improvement
 ANTIMICROBIAL THERAPY

8. Duration
7-10 days
Longer courses may be appropriate in Px w.
slow clinical response, undeniable foci of
infection, bacteremia with S. aureus, etc.
Shorter courses may be appropriate
9. Do daily assessment for de-escalation
10.Measure procalcitonin levels to support shortening
duration of therapy
 INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 SOURCE CONTROL

1. ID the source of infection

Specific anatomic diagnosis of infection

2. Prompt removal of intravascular access devices

that may be source
 INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 FLUID THERAPY

1. Apply fluid challenge technique where fluid

administration is continued
2. Crystalloids = fluid of choice for intravascular
volume replacement
Balanced crystalloids or saline for fluid

resuscitation
Albumin in addition to crystalloids when Px req.

substantial amounts of crystalloids

Crystalloids over gelatins when resuscitating Px

3. Not recommended: Hydroxyethyl starches

 INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 VASOACTIVE MEDICATIONS

1. Norepinephrine = first-choice vasopressor

Add vasopressin (up to 0.03 U/min) or
epinephrine to w/ intent of inc. MAP to target
Add vasopressin (up to 0.03 U/min) to decrease
norepinephrine
2. Dopamine as alternative only in highly selected
patients
Not recommended Low-dose for renal

protection
 VASOACTIVE MEDICATIONS

3. Dobutamine for Px who show evidence of

persistent hypo perfusion
4. Placement of arterial catheter for patients
requiring vasopressors
 INITIAL RESUSCITATION SOURCE CONTROL

SCREENING FOR SEPSIS

FLUID THERAPY
& PERFORMANCE IMPROVEMENT

DIAGNOSIS VASOACTIVE MEDICATIONS

ANTIMICROBIAL THERAPY CORTICOSTEROIDS

 CORTICOSTEROIDS

1. IV hydrocortisone
Not recommended if adequate fluid
resuscitation and vasopressor therapy can
restore hemodynamic stability
If needed IV hydrocortisone at 200mg per day