caused by a dysregulated host response to infection
Fakultas Kedokteran Universitas Andalas
METHODOLOGY
These clinical practice guidelines are a revision of the
2012 Surviving Sepsis Campaign (SSC) guidelines for the management of severe sepsis and septic shock Funding for the development of these guidelines was provided by SCCM and ESICM The selection of committee members was based on expertise in specific aspects of sepsis. All guideline questions were structured in PICO format, which described the population, intervention, control, and outcomes.
Fakultas Kedokteran Universitas Andalas
Grading of Recommendations Assessment, Development,and Evaluation (GRADE) system principles guided assessment of quality of evidence from high to very low and were used to determine the strength of recommendations
Fakultas Kedokteran Universitas Andalas
Fakultas Kedokteran Universitas Andalas Voting process Acceptance of a statement required votes from 75% of the panel members with an 80% agreement threshold.
Fakultas Kedokteran Universitas Andalas
A. INITIAL RESUSCITATION
1. Sepsis and septic shock are medical emergencies,and
we recommend that treatment and resuscitation begin immediately (BPS). 2. We recommend that, in the resuscitation from sepsis- induced hypoperfusion, at least 30 mL/kg of IV crystalloid fluid be given within the first 3 h (strong recommendation, low quality of evidence). 3. We recommend that, following initial fluid resuscitation,additional fluids be guided by frequent reassessment of hemodynamic status (BPS).
Fakultas Kedokteran Universitas Andalas
4. We recommend further hemodynamic assessment (such as assessing cardiac function) to determine the type of shock if the clinical examination does not lead to a clear diagnosis (BPS). 5. We suggest that dynamic over static variables be used to predict fluid responsiveness, where available (weak recommendation, low quality of evidence). 6. We recommend an initial MAP of 65 mm Hg in patients with septic shock requiring vasopressors (strong recommendation, moderate quality of evidence).
Fakultas Kedokteran Universitas Andalas
7. We suggest guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion (weak recommendation,low quality of evidence).
Fakultas Kedokteran Universitas Andalas
B. SCREENING FOR SEPSIS AND PERFORMANCE IMPROVEMENT
1. We recommend that hospitals and hospital systems have
a performance improvement program for sepsis, including sepsis screening for acutely ill, high-risk patients (BPS).
Fakultas Kedokteran Universitas Andalas
C. DIAGNOSIS
1. We recommend that appropriate routine
microbiologic cultures (including blood) be obtained before starting antimicrobial therapy in patients with suspected sepsis or septic shock if doing so results in no substantial delay in the start of antimicrobials (BPS). Remarks Appropriate routine microbiologic cultures always include at least two sets of blood cultures (aerobic and anaerobic).
Fakultas Kedokteran Universitas Andalas
D. ANTIMICROBIAL THERAPY
1. We recommend that administration of IV antimicrobials
be initiated as soon as possible after recognition and within 1 h for both sepsis and septic shock (strong recommendation, moderate quality of evidence; grade applies to both conditions).
Fakultas Kedokteran Universitas Andalas
2. We recommend empiric broad-spectrum therapy with one or more antimicrobials for patients presenting with sepsis or septic shock to cover all likely pathogens (including bacterial and potentially fungal or viral coverage) (strong recommendation, moderate quality of evidence). 3. We recommend that empiric antimicrobial therapy be narrowed once pathogen identification and sensitivities are established and/or adequate clinical improvement is noted (BPS).