Evidence-based guideline for screening, resuscitation, hemodynamic management, antimicrobial therapy, and organ support in sepsis and septic shock, synthesized from international critical care recommendations.
A comprehensive, evidence-based clinical guideline for the screening, early recognition, resuscitation, hemodynamic management, antimicrobial therapy, and organ support in adult patients with sepsis and septic shock. This resource synthesizes recommendations from the major international critical care professional societies, surviving sepsis working groups, infectious disease expert panels, and regulatory quality measures into a single integrated reference for intensivists, emergency physicians, hospitalists, and advanced practice providers who manage critically ill patients with suspected or confirmed sepsis.1 2 3 4 5 6
Sepsis remains a leading cause of death worldwide, with an estimated 48.9 million cases and 11.0 million sepsis-related deaths annually — representing nearly 20% of all global deaths. Hospital mortality in septic shock ranges from 30% to 50% depending on illness severity, comorbidities, and timeliness of intervention. The cornerstones of sepsis management — early recognition, rapid antimicrobial administration, appropriate fluid resuscitation, timely vasopressor initiation, and source control — are supported by strong evidence and form the basis of the hour-1 resuscitation bundle endorsed by the international critical care consensus.
Contents:
| Part | Title | Coverage |
|---|---|---|
| Part 1 | Definitions, Screening & Early Identification | Sepsis-3 definitions; SOFA and qSOFA scoring; septic shock criteria; comparison with SIRS/Sepsis-2; screening tools (NEWS, MEWS, qSOFA, SIRS) with sensitivity/specificity comparison; CMS quality measure criteria |
| Part 2 | Initial Resuscitation & Hemodynamic Management | Hour-1 bundle; fluid resuscitation strategy (crystalloid selection, 30 mL/kg initial bolus, reassessment); fluid responsiveness assessment (passive leg raise, pulse pressure variation, IVC ultrasound); MAP targets; vasopressor selection, dosing, and titration (norepinephrine, vasopressin, epinephrine, phenylephrine, dopamine, angiotensin II); inotrope use; hemodynamic monitoring modalities; lactate-guided resuscitation |
| Part 3 | Antimicrobial Therapy & Source Control | Timing of antibiotics; empiric broad-spectrum regimens by suspected source; de-escalation principles; duration of therapy; procalcitonin-guided discontinuation; antifungal considerations; source control timing and procedures; infected device removal |
| Part 4 | Corticosteroids & Organ Support | Corticosteroid indications and evidence (ADRENAL, APROCCHSS); mechanical ventilation in sepsis-induced ARDS; renal replacement therapy; blood product management; glucose management; DVT and stress ulcer prophylaxis; nutrition |
| Part 5 | Special Populations, Quality Metrics & Long-Term Outcomes | Sepsis in the immunocompromised; elderly patients; pregnancy; bundle compliance and quality metrics; post-sepsis syndrome; long-term outcomes; performance improvement |
Evans L, Rhodes A, Alhazzani W, et al. “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.” Crit Care Med. 2021;49(11):e1063-e1143. DOI: 10.1097/CCM.0000000000005337 ↩︎
Singer M, Deutschman CS, Seymour CW, et al. “The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).” JAMA. 2016;315(8):801-810. DOI: 10.1001/jama.2016.0287 ↩︎
Levy MM, Evans LE, Rhodes A. “The Surviving Sepsis Campaign Bundle: 2018 Update.” Crit Care Med. 2018;46(6):997-1000. DOI: 10.1097/CCM.0000000000003119 ↩︎
Rhee C, Chiotos K, Gershengorn HB, et al. “Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1).” Clin Infect Dis. 2021;72(4):541-552. DOI: 10.1093/cid/ciaa059 ↩︎
Dellinger RP, Levy MM, Rhodes A, et al. “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012.” Crit Care Med. 2013;41(2):580-637. DOI: 10.1097/CCM.0b013e31827e83af ↩︎
Seymour CW, Liu VX, Iwashyna TJ, et al. “Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).” JAMA. 2016;315(8):762-774. DOI: 10.1001/jama.2016.0288 ↩︎
Sepsis management in immunocompromised patients, elderly, and pregnancy; bundle compliance and quality metrics; post-sepsis syndrome; long-term outcomes and performance improvement.
Corticosteroid indications and evidence in septic shock, mechanical ventilation in sepsis-induced ARDS, renal replacement therapy, blood product management, glucose management, DVT and stress ulcer prophylaxis, and nutrition.
Timing of antibiotics, empiric broad-spectrum regimens by suspected source, de-escalation, duration of therapy, procalcitonin-guided discontinuation, antifungal considerations, and source control procedures.
Hour-1 bundle components, fluid resuscitation strategy, crystalloid selection, fluid responsiveness assessment, vasopressor selection and dosing, inotrope use, hemodynamic monitoring, and lactate-guided resuscitation.
Sepsis-3 definitions, SOFA and qSOFA scoring, septic shock criteria, comparison with SIRS/Sepsis-2, and screening tools (NEWS, MEWS, qSOFA, SIRS) with sensitivity and specificity data.