Wednesday, January 23, 2008

Wednesday January 23, 2008
Updated international guidelines for management of severe sepsis and septic shock - 2008

The updated Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock is now available.


Few important updates are:

1. Intravenous antibiotic therapy be started as early as possible and within the first hour of recognition of septic shock (1B) and severe sepsis without septic shock (1D)

2. Epinephrine be the first chosen alternative agent in septic shock that is poorly responsive to norepinephrine or dopamine

3. ACTH stimulation test not be used to identify the subset of adults with septic shock who should receive hydrocortisone

4. Xigris: adult patients with severe sepsis and low risk of death do not receive rhAPC (grade 1A). Adult patients with sepsis-induced organ dysfunction associated with a clinical assessment of high risk of death, most of whom will have APACHE II more than / = 25 or multiple organ failure, receive rhAPC if there are no contraindications (grade 2B except for patients within 30 days of surgery, for whom it is grade 2C).

5. Once tissue hypoperfusion has resolved (initial resuscitation) and in the absence of extenuating circumstances, such as myocardial ischemia, severe hypoxemia, acute hemorrhage, cyanotic heart disease, or lactic acidosis red blood cell transfusion to target a hemoglobin of 7.0-9.0 g/dL in adults

6. Erythropoietin not be used as a specific treatment of anemia associated with severe sepsis

7. Not to use pulmonary artery catheter for patients with ALI/ARDS in routine use
8. Targeting glucose levels to the less than150 mg/dL range

9. Not to use sodium bicarbonate for the purpose of improving hemodynamics or reducing vasopressor requirements in patients with hypoperfusion-induced lactic acidemia with pH more than / = 7.15

10. Not to use of SDD (Selective Digestive Tract Decontamination) specifically in severe sepsis - The guidelines group was evenly split on the issue of SDD, with equal numbers weakly in favor and against recommending the use of SDD. The final consensus on use of SDD in severe sepsis was achieved at the last nominal committee meeting

Also you can hear R. Phillip Dellinger M.D., one of the key person involved in drafting of these guidelines
here, from Surviving Sepsis Campaign - North American Summit - Denver 2007

Reference: click to get abstract

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 - Critical Care Medicine:Volume 36(1)January 2008pp 296-327

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