18488The 2016 updated guidelines for the management of sepsis and septic shock introduce best practice statements and the concept of a protocolised resuscitation procedure, with defined targets for blood pressure, urine output, and oxygen saturation, during the first six hours as part of the treatment approach.
Empiric antibiotic combination therapy is now recommended to ensure broad coverage, but it should be narrowed once the pathogen is identified.
The initial resuscitation should consist in the administration of at least 30ml/kg of crystalloids within a period of three hours, with frequent assessments of volume status throughout the procedure.
For patients with septic shock who require vasopressors, an initial target mean blood pressure of 65mmHg is recommended. Norepinephrine is the vasopressor of choice, and vasopressin or epinephrine can potentially be added to increase the mean arterial pressure.
Best practices for glucose monitoring of patients in the intensive care unit, renal replacement therapy in patients with concomitant acute kidney injury, and nutrition are also addressed.
Finally, the experts recommend that health facilities implement performance improvement programmes that include screening for sepsis in patients at risk and that clinicians discuss goals of care and prognosis with the patients and families.
