Which major new recommendations for the management of bacterial sepsis were published in 2012?

Updated: Feb 05, 2019
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Emphasis was directed to (1) first-hour fluid resuscitation and inotrope therapy directed to goals of threshold heart rates, normal blood pressure, and capillary refill of 2 seconds or less with specific evaluation after each bolus for signs of fluid overload, as well as first-hour antibiotic administration and (2) subsequent ICU hemodynamic support directed to goals of ScVO2 greater than 70% and cardiac index (CI) 3.3-6 L/min/m2 with appropriate antibiotic coverage and source control. [59]

Another major new recommendation in the 2012 update was that hemodynamic support of septic shock should be addressed at the institutional level rather than only at the practitioner level, with well-planned coordination between the family, community, prehospital, emergency department, hospital, and ICU settings. The 2012 guidelines recommend that each institution implement their own adopted or home-grown bundles that include the following:

  • Recognition bundle containing a trigger tool for rapid identification of patients with suspected septic shock at that institution
  • Resuscitation and stabilization bundle to drive adherence to consensus best practice at that institution
  • Performance bundle to monitor, improve, and sustain adherence to that best practice

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