Sepsis and septic shock: Guideline-based management

Sepsis is a life-threatening organ dysfunction that results from the body’s response to infection. It requires prompt recognition, appropriate antibiotics, careful hemodynamic support, and control of the source of infection. With the trend in management moving away from protocolized care in favor of appropriate usual care, an understanding of sepsis physiology and best practice guidelines is critical. Sepsis requires prompt recognition, appropriate antibiotics, careful hemodynamic support, and control of the source of infection.

[1]  Pierre Asfar,et al.  Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature , 2015, Critical Care.

[2]  Anand Kumar,et al.  Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. , 2009, Chest.

[3]  Brian H Cuthbertson,et al.  Hydrocortisone therapy for patients with septic shock. , 2008, The New England journal of medicine.

[4]  Dellinger Rp.  The Surviving Sepsis Campaign: Where have we been and where are we going? , 2015 .

[5]  M. Leeflang,et al.  Predicting Fluid Responsiveness by Passive Leg Raising: A Systematic Review and Meta-Analysis of 23 Clinical Trials* , 2016, Critical care medicine.

[6]  M. Levy,et al.  2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference , 2003, Intensive care medicine.

[7]  A. Armaganidis,et al.  An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients , 2012, Intensive Care Medicine.

[8]  M. J. Hall,et al.  Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. , 2011, NCHS data brief.

[9]  D. Annane,et al.  Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial , 2007, The Lancet.

[10]  K. Wood,et al.  Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock* , 2006, Critical care medicine.

[11]  S. Lawless,et al.  Hemodynamic effects of i.v. milrinone lactate in pediatric patients with septic shock. A prospective, double-blinded, randomized, placebo-controlled, interventional study. , 1996, Chest.

[12]  M. Levy,et al.  Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour: Results From a Guideline-Based Performance Improvement Program* , 2014, Critical care medicine.

[13]  P. Marik,et al.  The SEP-1 quality mandate may be harmful: How to drown a patient with 30 mL per kg fluid! , 2017, Anaesthesiology intensive therapy.

[14]  J. Sobel,et al.  Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  B. Souweine,et al.  Hydrocortisone plus Fludrocortisone for Adults with Septic Shock , 2018, The New England journal of medicine.

[16]  S. Lemeshow,et al.  Time to Treatment and Mortality during Mandated Emergency Care for Sepsis , 2017, The New England journal of medicine.

[17]  Peter Schlattmann,et al.  Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. , 2013, The Lancet. Infectious diseases.

[18]  Richard Beale,et al.  Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine , 2014, Intensive Care Medicine.

[19]  M. Hameed,et al.  Comparison of 8 VS. 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial , 2019 .

[20]  C. Sprung,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012 , 2013, Intensive Care Medicine.

[21]  C. Schermer,et al.  Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation , 2014, The British journal of surgery.

[22]  S. Jaber,et al.  Evaluation of pulse pressure variation validity criteria in critically ill patients: a prospective observational multicentre point-prevalence study. , 2014, British journal of anaesthesia.

[23]  Sangeeta Mehta,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 , 2017, Intensive Care Medicine.

[24]  R. Cavallazzi,et al.  Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature* , 2009, Critical care medicine.

[25]  R. Dellinger.  The Surviving Sepsis Campaign: Where have we been and where are we going? , 2015, Cleveland Clinic Journal of Medicine.

[26]  P. Marik,et al.  Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis , 2016, Intensive Care Medicine.

[27]  M. Taljaard,et al.  Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection , 2018, Annals of Internal Medicine.

[28]  R. Bellomo,et al.  Adjunctive Glucocorticoid Therapy in Patients with Septic Shock , 2018, The New England journal of medicine.

[29]  G. Guyatt,et al.  Corticosteroids in Sepsis: An Updated Systematic Review and Meta-Analysis , 2018, Critical care medicine.

[30]  Véronique Sébille,et al.  Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock , 2002 .

[31]  Fethi Gül,et al.  Changing Definitions of Sepsis. , 2017, Turkish journal of anaesthesiology and reanimation.

[32]  Adil Rafiq Rather,et al.  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) , 2015 .

[33]  G. Clermont,et al.  Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care , 2001, Critical care medicine.

[34]  Mitchell M. Levy,et al.  Lactate Measurements in Sepsis-Induced Tissue Hypoperfusion: Results From the Surviving Sepsis Campaign Database* , 2015, Critical care medicine.

[35]  E. Lang,et al.  Vasopressors for hypotensive shock. , 2013, Annals of emergency medicine.

[36]  R. Bone.  Guidelines for the Use of Innovative Therapies in Sepsis , 1993 .

[37]  Jesse M. Ehrenfeld,et al.  Balanced Crystalloids versus Saline in Critically Ill Adults , 2018, Journal Club AINS.

[38]  Sylvie Chevret,et al.  Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. , 2013, JAMA.

[39]  H. Ammar,et al.  Angiotensin II for the Treatment of Vasodilatory Shock. , 2017, The New England journal of medicine.

[40]  R. Bellomo,et al.  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). , 2016, JAMA.

[41]  W. Burdick.  A comparison of albumin and saline for fluid resuscitation in the Intensive Care unit , 2005 .

[42]  J. Greenslade,et al.  Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction: Insights From a Prospective Database of ED Patients With Infection , 2017, Chest.

[43]  Matthew M Churpek,et al.  Identifying Patients With Sepsis on the Hospital Wards , 2017, Chest.

[44]  W. Knaus,et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. , 1992, Chest.

[45]  T. Rea,et al.  Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). , 2016, JAMA.

[46]  L. Gattinoni,et al.  The clinical use of albumin: the point of view of a specialist in intensive care. , 2009, Blood transfusion = Trasfusione del sangue.

[47]  Sangeeta Mehta,et al.  Vasopressin versus norepinephrine infusion in patients with septic shock. , 2008, The New England journal of medicine.

[48]  Michael Bailey,et al.  Early, Goal‐Directed Therapy for Septic Shock — A Patient‐Level Meta‐Analysis , 2017, The New England journal of medicine.

[49]  J. Bakker,et al.  Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial , 2019, JAMA.

[50]  P. Marik,et al.  Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. , 2014, Anaesthesiology intensive therapy.

[51]  H. Gershengorn,et al.  Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock , 2017, JAMA.

[52]  Stephen D. Persell,et al.  Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study. , 2011, American journal of respiratory and critical care medicine.

[53]  E. Ivers,et al.  Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock , 2001 .

[54]  C. Sandoval.  Short-Course Versus Prolonged-Course Antibiotic Therapy for Hospital-Acquired Pneumonia in Critically Ill Adults. , 2016, Critical care nurse.

[55]  Michael Bailey,et al.  Goal-directed resuscitation for patients with early septic shock. , 2014, The New England journal of medicine.

[56]  C. Solano,et al.  Serum galactomannan versus a combination of galactomannan and polymerase chain reaction-based Aspergillus DNA detection for early therapy of invasive aspergillosis in high-risk hematological patients: a randomized controlled trial. , 2015, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[57]  J. Garnacho-Montero,et al.  De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock , 2013, Intensive Care Medicine.

[58]  Leonard Leibovici,et al.  Vasopressors for the Treatment of Septic Shock: Systematic Review and Meta-Analysis , 2015, PloS one.

[59]  Alan E. Jones,et al.  Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. , 2010, JAMA.

[60]  S. Townsend,et al.  Evidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1) , 2018, Annals of Internal Medicine.

[61]  Barrett T. Kitch,et al.  Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study* , 2018, Critical care medicine.

[62]  J. Vincent,et al.  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure , 1996, Intensive Care Medicine.

[63]  J. Marshall,et al.  Source control in the management of sepsis , 2001, Intensive Care Medicine.

[64]  J. Vincent,et al.  Comparison of dopamine and norepinephrine in the treatment of shock. , 2010, The New England journal of medicine.

[65]  Claude Guerin,et al.  High versus low blood-pressure target in patients with septic shock. , 2014, The New England journal of medicine.

[66]  Michel Wolff,et al.  Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. , 2003, JAMA.

[67]  R. Bellomo,et al.  Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial. , 2015, JAMA.

[68]  Amber E Barnato,et al.  A randomized trial of protocol-based care for early septic shock. , 2014, The New England journal of medicine.

[69]  Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock , 2003, Current infectious disease reports.

[70]  R. Fowler,et al.  Systematic Review and Meta-Analysis of Procalcitonin-Guidance Versus Usual Care for Antimicrobial Management in Critically Ill Patients: Focus on Subgroups Based on Antibiotic Initiation, Cessation, or Mixed Strategies* , 2018, Critical care medicine.

[71]  J. Tenhunen,et al.  Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. , 2012, The New England journal of medicine.

[72]  Joshua A. Doherty,et al.  Empiric Combination Antibiotic Therapy Is Associated with Improved Outcome against Sepsis Due to Gram-Negative Bacteria: a Retrospective Analysis , 2010, Antimicrobial Agents and Chemotherapy.

[73]  Michael Baram,et al.  Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. , 2008, Chest.

[74]  M. Vollmer,et al.  Quality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study* , 2017, Critical care medicine.

[75]  S. Lemeshow,et al.  Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study , 2014, Intensive Care Medicine.

[76]  J. Bakker,et al.  Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. , 2010, American journal of respiratory and critical care medicine.

[77]  B. Levy,et al.  Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study* , 2011, Critical care medicine.

[78]  Robyn Norton,et al.  A comparison of albumin and saline for fluid resuscitation in the Intensive Care unit , 2005 .

[79]  Mitchell M. Levy,et al.  2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference , 2003, Intensive Care Medicine.

[80]  J. Briegel,et al.  Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis: The HYPRESS Randomized Clinical Trial. , 2016, JAMA.

[81]  D. Mannino,et al.  The epidemiology of sepsis in the United States from 1979 through 2000. , 2003, The New England journal of medicine.

[82]  D. Annane,et al.  Corticosteroids for treating sepsis. , 2015, The Cochrane database of systematic reviews.

[83]  Chao Qi,et al.  Rapid Detection of Methicillin‐Resistant Staphylococcus aureus in BAL: A Pilot Randomized Controlled Trial , 2019, Chest.

[84]  G. Perkins,et al.  Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. , 2016, JAMA.

[85]  Tom Dormans,et al.  Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. , 2016, The Lancet. Infectious diseases.

[86]  E. Mylonakis,et al.  The Clinical Utility of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening to Rule Out MRSA Pneumonia: A Diagnostic Meta-analysis With Antimicrobial Stewardship Implications , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[87]  Thomas W. L. Scheeren,et al.  Current use of vasopressors in septic shock , 2019, Annals of Intensive Care.

[88]  G. Van den Berghe,et al.  Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017 , 2018, Intensive Care Medicine.

[89]  Mao Zhang,et al.  Albumin versus Other Fluids for Fluid Resuscitation in Patients with Sepsis: A Meta-Analysis , 2014, PloS one.

[90]  M. Mathru.  Initiation of Inappropriate Antimicrobial Therapy Results in a Fivefold Reduction of Survival in Human Septic Shock , 2010 .

[91]  J. Rello,et al.  Sepsis: A Review of Advances in Management , 2017, Advances in Therapy.

[92]  J. Vincent,et al.  Dopamine versus norepinephrine in the treatment of septic shock: A meta-analysis* , 2012, Critical care medicine.

[93]  Derek Bell,et al.  Trial of early, goal-directed resuscitation for septic shock. , 2015, The New England journal of medicine.

[94]  S. Lemeshow,et al.  Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. , 2015, Critical care medicine.

[95]  Mervyn Singer,et al.  Biomarkers in sepsis , 2013, Current Opinion in Pulmonary Medicine.

[96]  Jian-feng Xie,et al.  Effect of levosimendan on mortality in severe sepsis and septic shock: a meta-analysis of randomised trials , 2018, BMJ Open.

[97]  Anand Kumar,et al.  Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis , 2017, Critical care medicine.

[98]  C. Rhee,et al.  The CMS Sepsis Mandate: Right Disease, Wrong Measure , 2016, Annals of Internal Medicine.

[99]  C. Sprung,et al.  The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock , 2009, Intensive Care Medicine.