- Sepsis treatment should begin within 1 hour of presentation.
Why this matters
- Completion of Surviving Sepsis Campaign (SSC) 3-hour bundle, not including fluid bolus, is linked to survival.
- Measure lactate; if >2 mmol/L, repeat after 2-4 hours (weak recommendation, low evidence quality).
- Obtain aerobic, anaerobic blood cultures before antibiotic administration; do not delay latter to obtain former (best practice).
- Begin empiric broad-spectrum antibiotics (strong recommendation, moderate evidence quality).
- If hypotension or lactate >4 mmol/L, give, e.g., 30 mL/kg intravenous crystalloid fluid (strong recommendation, low evidence quality).
- Exercise caution continuing fluids in fluid-unresponsive patient; evidence suggests harm with ongoing positive fluid balance.
- With hypotension during/after fluid resuscitation, begin vasopressors for mean arterial pressure ≥65 mmHg (strong recommendation, moderate evidence quality).
- Suboptimal evidence quality for most elements.
- Insufficient data for subgroups (immunocompromised, burn patients).
- Several days after this article appeared online, Intensive Care Medicine released expert consensus statement on managing hypovolemia in patients with sepsis.
- This article simultaneously appeared in Critical Care Medicine.