Sepsis Pearls from the Recent Literature

• 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.