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International
Guidelines for
Management of
Severe Sepsis and
Septic Shock: 2016
Intensive Care Medicine
doi: 10.1007/s00134-017-4683-6
Published online: 18 Jan 2017
MANAGEMENT OF SEVERE SEPSIS
Management of Severe Sepsis
Initial Antibiotic
Resuscitation Diagnosis Therapy
Source
Fluid Therapy Vasopressors
Control
Corticosteroids
Glucose
Blood Product
Control
Bicarbonate
Therapy
Initial
Resuscitation
Initial Resuscitation
Sepsis and septic shock are medical emergencies,
and we recommend that treatment and
resuscitation begin immediately (best practice
statements, BPS).
In the resuscitation from sepsis-induced
hypoperfusion, at least 30 mL/kg of IV
crystalloid fluid be given within the first 3 h
(strong recommendation, low quality of
evidence).
Initial Resuscitation
Following initial fluid resuscitation, additional
fluids be guided by frequent reassessment of
hemodynamic status (BPS).
Remarks Reassessment should include a thorough
clinical examination and evaluation of available
physiologic variables (heart rate, blood pressure,
arterial oxygen saturation, respiratory rate,
temperature, urine output, and others, as available)
as well as other noninvasive or invasive monitoring,
as available.
Initial Resuscitation
An initial target MAP of 65 mmHg in patients
with septic shock requiring vasopressors (strong
recommendation, moderate quality of evidence).
Guiding resuscitation to normalize lactate in
patients with elevated lactate levels as a marker
of tissue hypoperfusion (weak recommendation,
low quality of evidence).
Application of Fluid Resuscitation in Adult Septic Shock
Sepsis-induced hypotension or lactate > 4 mmol/L
(Based on SSC bundle and CMS threshold)
No high flow oxygen and Pneumonia or ALI with high ESRD on hemodialysis
No ESRD on dialysis or CHF flow oxygen requirements or CHF
Add vasopressin up to
Connue norepinephrine alone or
0.03 units/min to achieve
add vasopressin 0.03 units/min
MAP target*
with ancipaon of decreasing
norepinephrine dose