Revised Sepsis Guidelines to Emphasize Best Practices
FROM THE ANNUAL MEETING OF THE SOCIETY FOR ACADEMIC EMERGENCY MEDICINE
Initial Resuscitation
The guidelines now recommend a quantitative resuscitation protocol for patients with sepsis-induced shock, defined as tissue hypotension persisting after initial fluid challenge or blood lactate concentration of 4 mmol/L or more. The guidelines previously identified central venous pressure of 8-12 mm Hg, mean arterial pressure of at least 65 mm Hg, and urine output of at least 0.5 mL/kg per hour as treatment goals during the first 6 hours of resuscitation, and now add central venous (superior vena cava) or mixed venous oxygen saturation of at least 70% or at least 65%, respectively, as a fourth goal.
In patients with elevated lactate levels as a marker of tissue hypoperfusion, the guidelines for the first time suggest targeting resuscitation to normalize lactate as rapidly as possible. Several studies have recently looked at lactate clearance using a target of less than 10%, but in the absence of data on other lactate levels, the committee thought it made more sense to suggest lactate be normalized rather than to shoot for a specific level of clearance, Dr. Jones said.
The Surviving Sepsis Campaign guidelines for severe sepsis and septic shock were last updated in 2008 (Crit. Care Med. 2008;36:296-327). More than 25 international professional medical societies were represented in the review and revision process.
The Gordon and Betty Moore Foundation provides grant support for the Surviving Sepsis Campaign.
