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

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
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