Updates and Controversies in the Early Management of Sepsis and Septic Shock

<< Updates and Controversies in the Early Management of Sepsis and Septic Shock (Pharmacology CME)

Points and Pearls Digest

Points and Pearls Excerpt

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
Sepsis is the most expensive cause of hospitalization.
The systemic inflammatory respiratory syndrome (SIRS) criteria have poor sensitivity and specificity for identifying sepsis.
Sepsis-3 proposed a new bedside assessment tool called qSOFA (quick systemic organ failure assessment). qSOFA has 3 components: (1) respiratory rate > 22 breaths/min, (2) altered mental status, and (3) systemic blood pressure (SBP) ≤ 100 mm Hg. Having 2 or more criteria in the correct clinical setting is suggestive of sepsis.

Most Important References

Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-801. (Policy) DOI: http://dx.doi.org/10.1001/jama.2016.0287
Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301-1311. (Randomized clinical trial; 1260 patients) DOI: http://dx.doi.org/10.1056/NEJMoa1500896
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. (Retrospective; 706,399 patients) DOI: http://dx.doi.org/10.1001/jama.2016.0288
Pandharipande PP, Shintani AK, Hagerman HE, et al. Derivation and validation of SpO2/FiO2 ratio to impute for PaO2/FiO2 ratio in the respiratory component of the sequential or-gan failure assessment score. Crit Care Med. 2009;37(4):1317-1321. (Prospective observational; 2986 patients) DOI: http://dx.doi.org/10.1097/CCM.0b013e31819cefa9
Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739- 746. (Clinical trial; 300 patients) DOI: http://dx.doi.org/10.1001/jama.2010.158
Puskarich MA, Trzeciak S, Shapiro NI, et al. Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Crit Care Med. 2011;39(9):2066-2071. (Clinical trial; 291 patients) DOI: http://dx.doi.org/10.1097/CCM.0b013e31821e87ab
De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-789. (Clinical trial; 1679 patients) DOI: http://dx.doi.org/10.1056/NEJMoa0907118Management