We reviewed the history of sepsis, and re-lived the times of EGDT (early goal directed therapy). The data eventually showed no difference in outcomes and actually increased costs! We also learned that the use of “SIRS” criteria were not helpful and are no longer included.
We learned helpful definitions….
- Sepsis guidelines have had several iterations, and in current use is the 2016 Sepsis 3 Guidelines.
- Sepsis definition: A life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more (or 2 point rise from baseline score)
- Septic shock definition: subset of sepsis with particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality (i.e. MAP <65, lactate > 2 after fluid bolus)
- “Severe sepsis” is superfluous!
- 30 ml/kg of crystalloid solution (most often LR, not normal saline) for sepsis induced hypoperfusion (MAP <65) or lactate >4, and continue to resuscitate to lactate <2
- Obtain blood cultures and start appropriate antibiotic therapy (preferably within an hour)
- Norepinephrine is the pressor of choice if patient’s blood pressure not responsive to fluid bolus, and you can consider corticosteroids & blood transfusions if clinically indicated.
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