Should Hemodynamic Profiling be a Sepsis Best Practice?

SUMMARY

  • Surviving Sepsis Campaign (SSC) guidelines were previously developed in 2016 and published in 2017.
  • The SSC 2021 guidelines provides an update to the SSC 2016 guidelines.
  • New recommendations are provided for a number of areas in the management of sepsis.

BACKGROUND

  • Relevant English language articles prior to 2019 were reviewed.
  • Six SSC workgroups were developed:
    a. Screening and Initial Resuscitation
    b. Infection
    c. Hemodynamics
    d. Ventilation
    e. Additional Therapies
    f. Goals of Care and Long Term Outcome
  • The statements were distributed as follows:

REVIEW

  • There is increased attention to rapid and continued assessment of infectious vs non-infectious etiologies of acute illness.
  • An effort to not start antimicrobials in low likelihood cases of sepsis and quickly discontinue is occurring with new antimicrobial administration guidelines
  • This impacts the early bundles:

    One Hour: Administer antimicrobials in high probability sepsis cases or those with
    septic shock

    Three Hour: Administer antimicrobials within 3 hours in cases of possible sepsis
    where infection concern persists.

    Defer Antimicrobials in low probability sepsis cases and look for another cause of
    inflammation

  • Norepinephrine is still preferred.
  • Add vasopressin, however the threshold at which to add vasopressin is unclear
  • Add dobutamine or switch to epinephrine if cardiac dysfunction persists

New guidelines on Vasoactive Agent administration

CONCLUSIONS: KEY CHANGES

  • A strong recommendation for each hospital to develop a sepsis quality improvement program
  • Continuous assessment and evaluation of patients for:
    • Other causes
    • Optimizing therapy
  • Clarification of the Hour-1 vs 3-Hour bindle requirements
  • Administration clarification for:
    • Antimicrobials
    • Fluids
    • Corticosteroids
    • Neuromuscular blockers
  • Addition of guidelines for long term outcome considerations

To receive articles like these in your Inbox, you can subscribe to Sepsis Program Optimization Insights.

Subscribe to sepsis program optimization insights

Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.