Management of Sepsis: Understanding the Serious Illness

8 Strategies in Management of Sepsis

Sepsis is a serious illness.
It happens when your body has an overwhelming immune response to a bacterial infection.
The chemicals released into the blood to fight the infection trigger widespread inflammation.
This leads to blood clots and leaky blood vessels.
They cause poor blood flow, which deprives your body’s organs of nutrients and oxygen. In severe cases, one or more organs fail.

In the worst cases, blood pressure drops and the heart weakens, leading to septic shock. Anyone can get sepsis, but the risk is higher in:

- People with weakened immune systems.
- Infants and children.
- The elderly.
- People with chronic illnesses, such as diabetes, AIDS, cancer, and kidney or liver disease.
- People suffering from a severe burn or physical trauma.

Protocolised, quantitative resuscitation of patients with sepsis-induced tissue hypoperfusion (defined in this document as hypotension persisting after initial fluid challenge or blood lactate concentration ≥ 4 mmol/L).

Administration of effective intravenous antimicrobials within the first hour of recognition of septic shock, and severe sepsis without septic shock.

A specific anatomical diagnosis of infection requiring consideration for emergent source control

Selective oral decontamination and selective digestive decontamination should be introduced and investigated as a method to reduce the incidence of ventilator-associated pneumonia; This infection control measure can then be instituted in health care settings and regions where this methodology is found to be effective.
Oral chlorhexidine gluconate is used as a form of oropharyngeal decontamination to reduce the risk of ventilator-associated pneumonia in ICU patients with severe sepsis.

Crystalloids as the initial fluid of choice in the resuscitation of severe sepsis and septic shock Colloids also can be used.

Norepinephrine as the first choice vasopressor.
Epinephrine (added to and potentially substituted for norepinephrine) when an additional agent needed to maintain adequate blood pressure.
Vasopressin 0.03 units/minute added to norepinephrine (NE) with the intent of either raising MAP or decreasing NE dosage (UG).
Dopamine as an alternative vasopressor agent to norepinephrine only in highly selected patients (eg, patients with low risk of tachyarrhythmias and absolute or relative bradycardia)

A trial of dobutamine infusion up to 20 micrograms/kg/min be administered or added to vasopressor (if in use) in the presence of

(a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output.

(b) ongoing signs of hypoperfusion, despite achieving adequate intravascular volume and adequate MAP (grade 1C).
Not using a strategy to increase cardiac index to predetermined supranormal levels.

Not using intravenous hydrocortisone to treat adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (see goals for Initial Resuscitation). In case this is not achievable, we suggest intravenous hydrocortisone alone at a dose of 200mg per day (grade 2C).
Not using the ACTH stimulation test to identify adults with septic shock who should receive hydrocortisone (grade 2B).