Surviving Sepsis Campaign: Management of Sepsis and Septic Shock 2021

Patient Guideline Summary

Publication Date: October 1, 2021

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the European Society of Intensive Care Medicine and the Society of Critical Care Medicine (SCCM) for the surviving sepsis campaign: management of sepsis and septic shock 2021.

Overview

Sepsis is a life-threatening bacterial infection that has spread throughout the body. Severe medical conditions can weaken the body and render it susceptible to sepsis.

Causes can be localized infections or serious non-infectious diseases.

Symptoms include fever, weakness, confusion, and pain.

This patient summary focuses on preventing and treating sepsis.

All diagnostic and treatment procedures have standardized protocols to guide management. They are meant to be adapted so that all decisions are specific to your individual situation.

Diagnosis

If you are critically ill you will have multiple concerns, all of which need constant simultaneous attention for the best outcome.
- Your lungs may need oxygen and assisted ventilation, perhaps even a tube in your airway.
  - A condition called acute respiratory distress syndrome (ARDS) is a potentially fatal lung condition that requires maximum treatment.
- Your heart, blood pressure, and circulation may need medicines – maybe even machines – to keep your body’s organs functioning properly, particularly your kidneys and brain.
  - “Shock” describes blood pressure so low it threatens organ function.
- You will need water and nutrition, which may be delivered by mouth, tube, or intravenous catheter.
- Additional infections are a major threat when your body is weakened by a serious initial infection.
- Expect repeated measurements of vital signs, blood and urine tests, oxygen levels, and other data to assess your progress.

Treatment

Sepsis and shock are emergencies requiring immediate treatment.
Critically ill patients are treated in intensive care units where maximum resources are available, including:
- For your lungs
  - Oxygen from a nasal tube or face mask
  - Mechanical breathing assistance with a tube in your airway
  - Positive end-expiratory pressure (PEEP) is a treatment that helps keep your airway and lungs open.
- For your heart and circulation
  - Medications to maintain blood pressure
  - Prevention of blood clots
  - Blood or blood product transfusions
  - Mechanical circulation assistance
- For your kidney function
  - Dialysis
- For infections
  - Antibiotics, are usually begun immediately and modified as information accrues.
  - Cortisone sometimes helps your system to heal.
- For your fluid and nutrition
  - An intravenous catheter will supply fluids, electrolytes, glucose, and medications.
  - Additional nutrition may be given through a tube if you are unable to eat.
  - Insulin is often given to stabilize blood glucose.
- For your comfort
  - Medications for pain and stress
  - Prevention of stress stomach ulcers
  - Sedation or anesthesia
  - As much movement and physical activity as possible
Options are chosen based on continuous assessment of your condition and will change as your condition changes.
Some advanced measures may require transfer to a medical center specializing in those treatments.
The SCCM recommends regular discussions with you and your family and loved ones to encourage shared decision-making. Topics include:
- Goals of care and prognosis
- Sepsis education
- Economic and social support
- Peer support groups after recovery
- A follow-up to recognize and manage physical, cognitive, and emotional problems that frequently follow critical illness
- Palliative care if full recovery is in doubt

Abbreviations

ARDS: Acute Respiratory Distress Syndrome
PEEP: Positive End-expiratory Pressure

Source Citation

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-1247. doi: 10.1007/s00134-021-06506-y. Epub 2021 Oct 2. PMID: 34599691; PMCID: PMC8486643.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.