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

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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.