Sepsis: Guideline Changes Highlighted for ED Clinicians

Steven Fox

October 07, 2013

Updated guidelines for managing severe sepsis and septic shock have direct implications for personnel working in emergency departments, according to a review published online September 25 in the Annals of Emergency Medicine.

The Surviving Sepsis Campaign, launched in 2002, is a joint effort of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. The campaign updated sepsis guidelines in 2012 to reflect knowledge gained since the previous update in 2008.

In the current review, Alan E. Jones, MD, from the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, and colleagues, highlight information in the guideline that is essential for emergency department clinicians.

"The goal of this review is to provide the emergency practitioner a synopsis of the recent changes in guidelines, with a particular emphasis on those that may have direct implications for ED assessment and management of early sepsis."

The review also provides brief discussions of the various studies that prompted the guideline revision.

The 2012 update for the Surviving Sepsis Campaign introduced several important changes in recommendations relevant for treating severe sepsis and septic shock in emergency departments. They include:

  • use of protocolized quantitative resuscitation with specific physiologic targets,

  • preferential use of crystalloids (with or without albumin) for volume resuscitation,

  • preferential use of norepinephrine,

  • addition of lactate clearance as a marker of tissue hypoperfusion, and

  • decreased emphasis on the use of corticosteroids.

One section of the updated guidelines provides what is referred to as a "sepsis care bundle," which specifies interventions that should be completed within 3 or 6 hours of triage.

The guidelines recommend that within 3 hours of triage, lactate levels be measured, blood cultures be obtained, broad-spectrum antibiotics be administered as indicated, and crystalloid or lactate be administered for hypotension.

Within 6 hours, the guidelines recommend that vasopressors be used to control hypotension that has remained unresponsive to fluid resuscitation. If arterial hypotension persists despite volume resuscitation or initial administration of lactate, the guidelines advise measuring central venous pressure and central venous oxygen saturation. They also recommend remeasuring lactate if initial lactate levels were elevated.

The authors have disclosed no relevant financial relationships.

Ann Emerg Med. Published online September 25, 2013. Abstract


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