Lessons in Transport - Surviving Sepsis Part 2

surviing sepsis campaign
surviing sepsis campaign

"Around every 3rd heartbeat someone dies of sepsis"

Blood Product Administration:

  • Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial ischemia, severe hypoxemia, acute hemorrhage, or ischemic heart disease, we recommend that red blood cell transfusion occur only when hemoglobin concentration has decreased to < 7.0 g/dL to target a hemoglobin concentration of 7.0-9.0 g/dL in adults (grade 1B).
  • FFP NOT be used to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures (grade 2D).

Ventilator Management:

  • Target a tidal volume of 6 ml/kg predicted body weight in patients with sepsis-induced ARDS (grade 1A)
  • Plateau pressures be measured in patients with ARDS and initial upper limit goal for plateau pressures in a passively inflated lung be < 30cm H2O (grade 1B)
  • Strategies based on higher rather than lower levels of PEEP be used for patients with sepsis-induced moderate or severe ARDS (grade 2C).
  • Mechanically ventilated sepsis patients be maintained with the head of the bed elevated to 30-45 degrees to limit aspiration risk and to prevent the development of ventilator-associated pneumonia (grade 1B).
  • A conservative rather than liberal fluid strategy for patients with established sepsis-induced ARDS who do not have evidence of tissue hypoperfusion (grade 1C).

Sedation, Analgesia, and Neuromuscular Blockade in Sepsis:

  • Continuous or intermittent sedation be minimized in mechanically ventilated sepsis patients, targeting specific titration endpoints (grade 1B).
  • A short course of NMBA of not greater than 48 hours for patients with early sepsis-induced ARDS and a PaO2/FiO2 < 150 mmHg (grade 2C).

Miscellaneous:

  • Glucose control should target < 180mg/dL
  • Do not use sodium bicarbonate therapy for the purpose of improving hemodynamics or reducing vasopressor requirements in patients with hypoperfusion-induced lactic acidemia with pH > 7.15 (grade 2B).
  • Discuss goals of care and prognosis with patients and families (grade 1B).

For additional information and reading:http://www.survivingsepsis.org/Pages/default.aspx http://pulmccm.org/main/2013/review-articles/surviving-sepsis-guidelines-2013-review-update/