Sepsis remains one of the most common critical illnesses managed by emergency physicians and intensivists.
Recent publications and meta-analyses (i.e., ProCESS, ALBIOS, SEPSISPAM) have further refined the management of these complex patients.
A few pearls from the recent literature:
Early broad-spectrum antibiotics remains the most important factor in reducing morbidity and mortality.
Appropriate fluid resuscitation with a balanced crystalloid solution targeting 30 ml/kg. Use a dynamic measure of volume responsiveness to determine if additional fluid needed (i.e., PLR with a minimally invasive or noninvasive cardiac output monitor)
Maintain adequate tissue perfusion with IVFs and vasopressors (norepinephrine) targeting a MAP > 65 mm Hg. Patients with chronic HTN may benefit from a higher MAP goal. If the diastolic BP is < 40 mm Hg upon presentation, start vasopressors concurrent with IVF resuscitation.
References
Marik PE. Early management of severe sepsis: concepts and controversies. Chest 2014; 145:1407-18.
Rochwerg B, et al. Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med 2014 [epub ahead of print]
Raghunathan K, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. Crit Care Med 2014; 42:1585-91.
