Review of recent guidelines for the management of severe sepsis and septic shock

Abstract

Severe sepsis and septic shock affect millions of patients and are major causes of mortality worldwide. Advancements in treatment and disease management led to a decline in in-hospital mortality from 27.8% (1979–1984) to 17.9% (1995 to 2000). In this article, we systemically review recent guidelines for the management of severe sepsis and septic shock published in 2008 by the International Surviving Sepsis Campaign Guidelines Committee. The 2008 Surviving Sepsis guidelines recommend protocolized resuscitation with goals to maintain central venous pressure≥8–12mmHg, mean arterial pressure≥65mmHg, urine output≥0.5mL·kg^−1·h^−1 and central venous oxygen saturation≥70% (or mixed venous≥65%). Further fluid administration, transfusion of packed red blood cells to achieve a hematocrit of≥30% and/or infusion of dobutamine max 20µg·kg^−1·min^−1 are advised if venous O₂ saturations remain below 70%. In patients with decreased ventricular compliance or mechanical ventilation, a target central venous pressure of 12–15mmHg is recommended. Intravenous antibiotic administration within the first hour of recognizing severe sepsis and septic shock is essential, while use of corticosteroids in sepsis is controversial. The mechanisms by which activated protein C improves clinical outcomes in sepsis are unknown. Therapy with activated protein C is approved for patients with severe sepsis and an increased risk of death [Acute Physiology and Chronic Health Evaluation II (APACHE II)>25]. Bicarbonate therapy is discouraged. Intravenous insulin should be used to control hyperglycemia in patients with severe sepsis following stabilization in the intensive care unit.

Keywords

sepsis / septic shock / hemodynamics / guidelines