Surviving Sepsis Guidelines 2016

Surviving Sepsis Guidelines 2016 from Sun Yai-Cheng

Surviving Sepsis Campaign:
International Guidelines for Management of Sepsis and Septic Shock: 2016

Intensive Care Medicine 2016
doi: 10.1007/s00134-017-4683-6


Initial Resuscitation
☑ Crystalloid fluid ≥ 30 ml/kg within the first 3 hrs
☐ Target MAP ≥ 65 mmHg
☐ Normalize lactate
☒ EGDT, CVP, ScvO2

Antimicrobial Therapy
☐ Empiric broad-spectrum antibiotics within 1 hr
☐ Procalcitonin to support the discontinuation of antibiotics

Source Control
☐ As soon as possible

Fluid Therapy
☑ Crystalloids ± albumin
☒ HESs

Vasopressors
☑ Norepinephrine ± vasopressin or epinephrine
☐ Dopamine only in bradycardia

Corticosteroids
☐ Hydrocortisone 200 mg per day for refractory shock

Blood Products
☐ pRBC: Hb < 7
☐ platelet: 10K, 20K, 50K

Glucose Control
☐ Target blood glucose ≤ 180 mg/dl

Bicarbonate Therapy
☐ pH < 7 .15

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《Surviving Sepsis Guidelines 2016 改版摘要》

初步復甦

• 3小時內給予 Crystalloid fluid ≥ 30 ml/kg
• 復甦目標 MAP > 65 mmHg, lactate 降至正常
• EGDT, CVP, ScvO2 不再被建議用來評估復甦成效！改以非侵入性動態指標監測
• 不建議使用 hydroxyethyl starches 作為急救輸液

一小時內給予廣效性經驗性抗生素治療
利用 procalcitonin 輔助決定是否停用抗生素

第一線強心劑首選：Levophed

輸血時機：Hb小於 7
輸血小板時機：
    血小板 < 1萬
    血小板 < 2萬，有出血風險
    血小板 < 5萬，有出血或執行侵入性處置

血糖控制目標 ≤ 180 mg/dl

Bicarbonate 時機： pH 小於 7.15