Treatment of Sepsis

Sepsis is a medical emergency.

The accepted principles of treatment include prompt administration of antibiotics (target to administer within one hour of suspecting sepsis), source control, intravenous fluid therapy and organ system support with vasopressor drugs, mechanical ventilation, and renal replacement therapy as required.

Surviving Sepsis Campaign Guidelines 2021

Critical Care Medicine: October 4, 2021

International Guidelines for Management of Sepsis and Septic Shock 2021

Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.

The new guidelines specially address challenges to treating patients experiencing the long-term effects of sepsis are also addressed in the guidelines. Patients often have lengthy ICU stays and then face a long and complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families often are uncertain how to coordinate care that promotes recovery and matches their goals of care.

To address these issues, the guidelines recommend involving patients and their families in goals-of-care discussions and hospital discharge plans, which should include early and ongoing follow-up with clinicians to support and manage long-term effects and assessment of physical, cognitive, and emotional issues after discharge.

Immediate management

  • Assess for airway patency and administer oxygen
  • Obtain IV access, blood cultures and baseline blood tests (including lactate)
  • Other diagnostic samples if they will not delay antibiotic treatment (e.g. sputum, urine, pus)
  • Prescribe and administer appropriate antibiotics (should ideally be administered in first hour)
  • Seek early senior clinical advice in all cases
  • IV fluid bolus if patient showing signs of shock/hypoperfusion – 250-500 mL crystalloid (e.g. N/Saline, Hartmanns or Plasmalyte according to local approved protocols) repeated as required.
  • Assess for the need for vasopressors to avoid fluid overload
  • Transfer to ICU if transient or no response to treatment
  • Examination for source of sepsis if not already clear
  • Monitor fluid balance and urine output