Sepsis

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Sepsis guidelines are constantly changing. Refer to your national guidelines or institutional protocol for most up to date treatment information.

Introduction

• Sepsis is bad and needs to be treated aggressively
• Confusion around multiple conflicting guidelines and requirements
  • Surviving Sepsis Campaign recommendations
  • CMS requirements
  • Sepsis-3
  • SOFA/SIRS/qSOFA
  • Institutional protocols

Sepsis-3 Proposed Recommendations

• Screen for sepsis by applying qSOFA instead of SIRS criteria
  • qSOFA criteria
    • Altered mental status
    • Tachypnea
    • Hypotension
  • SIRS criteria
    • Tachycardia
    • Tachypnea
    • Leukocytosis
    • Hyper/hypothermia
  • qSOFA criteria miss cases of sepsis (too specific)
  • SIRS calls everything “sepsis” even if the patient is fine (too sensitive)
• Change definition of “Sepsis” (no more SIRS plus source)
  • New definition
    • Source of infection
    • PLUS
    • Organ disfunction
      • Determined by SOFA score (different purpose than qSOFA)
• Eliminate the term “severe sepsis” completely
• Redefine “septic shock”
  • Persistent hypotension
  • OR
  • Lactic acid >4

Current Approach to Sepsis

• Step 1- If the patient has SIRS plus source
  • Get labs including a lactic acid
• Step 2- If the patient has organ dysfunction
  • Diagnose sepsis
• Step 3- If the patient has sepsis
  • Order broad spectrum antibiotics
  • Order blood cultures
  • Needs to be completed in <3 hours
• Step 4- If the patient has persistent hypotension or lactate >4
  • Diagnose septic shock
• Step 5- If they have septic shock
  • Give 30ml/kg crystalloid bolus
  • Start vasopressers if hypotension doesn’t improve with bolus

Additional Reading

• CMS Sepsis Core Measures (ACEP)
• Sepsis-3 Recommendations (EMJ)
• Surviving Sepsis Campaign (SCCM)