Home Critical Care Managing sepsis and septic shock

Managing sepsis and septic shock

A look at the most recent guidelines and the latest evidence

December 2023
severe sepsis

WHILE THE NEWS may have been buried a bit during the pandemic, the Surviving Sepsis Campaign issued revised guidelines in 2021 that offer more than 90 recommendations on managing sepsis and septic shock.

According to a presentation at a hospital medicine conference this year, the latest iteration reaffirmed a lot of what clinicians were already doing to treat sepsis. In the “Keep” column from previous guidelines, for instance, norepinephrine remains the first-line vasopressor.

But the guidelines also highlighted items that doctors should toss, like treating sepsis with vitamin C and scoring sepsis with qSOFA. As for what to start using, balanced crystalloids made the list, while new studies suggest antibiotic options. And—surprise!—clinicians should now start steroids in patients with septic shock.

Sepsis update: antibiotics and pressors

prescribing-prophylactic-antibioticsThe 2021 guidelines, reviewed by Lekshmi Santhosh, MD, MA, an intensivist at the University of California, San Francisco, reaffirmed a lot of what clinicians were already doing to treat sepsis. In the “Keep” column from previous guidelines, for instance, norepinephrine remains the first-line vasopressor.

And early antibiotics are still key. Something else to do early: Address goals of care.

The guidelines did, however, highlight items that should be tossed. According to the new recommendations, no one should consider using vitamin C to treat sepsis. “There have been numerous trials,” said Dr. Santhosh. “That nail is in the coffin.” Read more here.

Sepsis update: fluids and steroids

iv-fluids-sepsisLekshmi Santhosh, MD, MA, an intensivist at the University of California, San Francisco, who spoke at UCSF’s hospital medicine conference this fall. provided several sepsis updates, including which fluids to use.

As Dr. Santhosh explained, Medicare a few years ago threatened to come down hard on any clinician who wasn’t giving 30 cc/kg of IV fluids to every septic patient within the first two hours. Read more here.

Phyllis Maguire is Executive Editor of Today’s Hospitalist.

Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments