Should Hemodynamic Profiling be a Sepsis Best Practice?


  • 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.


  • 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:


  • 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

  • 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


  • 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 (, or video chat.