20th May 2024

Management

The management is based on improving tissue oxygenation and perfusion and providing suitable antimicrobial therapy. Often, hospitals use sepsis bundles to protocolise sepsis management to ensure patients receive adequate and timely care. The basics of management include early antibiotic administration (within 1 hour of recognition of sepsis) and fluid resuscitation.

There is no convincing evidence that anything other than crystalloid fluid is superior, although there may be a role for albumin-containing solutions. The volume of fluid to administer varies and there is no optimum. Hypo-perfused patients should receive 30ml/kg of IV crystalloid, however one must be wary of overzealous fluid administration, particularly if the response is poor. Evidence has shown that fluid overload in septic patients is associated with poorer outcomes. For those with a focus on infection, source control should take place within 12 hours.

Early goal directed therapy is sometimes used to protocolise the management of sepsis. This involves physiological targets, namely a MAP of 65mmHg, urine output of 0.5ml/kg/hour, central venous pressure of 8-12mmHg, superior vena cava oxygen saturation of 70% or mixed venous oxygen saturation of 65%. While more recent trials have shown that mortality is not necessarily reduced when the above parameters are adhered to, they are still often used as targets in level 2 and level 3 care of patients with septic shock.