SepsisManagement

Sepsis management encompasses the clinical strategies used to identify and treat sepsis and septic shock, a life-threatening organ dysfunction caused by infection. Early recognition and timely intervention improve outcomes. Clinicians use sepsis screening tools and organ dysfunction scores such as SOFA or quick SOFA to stratify risk.

Initial steps include obtaining appropriate cultures before antibiotics when feasible, and starting broad-spectrum intravenous antibiotics within one hour for suspected sepsis or septic shock, with later narrowing based on culture results (antibiotic stewardship).

Fluid resuscitation, hemodynamic support: For adults with septic shock or hypoperfusion, administer 30 mL/kg of crystalloids within the first 3 hours, reassessing volume status. If hypotension persists after fluids, start vasopressors, with norepinephrine as first-line to achieve mean arterial pressure (MAP) ≥65 mmHg. Consider arterial catheter for continuous monitoring.

Source control: Identify and remove or drain the source of infection as soon as feasible, through procedures, drainage, or device removal.

Supportive care: Provide supplemental oxygen to maintain adequate oxygenation; use mechanical ventilation if needed. Monitor lactate and tissue perfusion; reassess antibiotic regimen to avoid unnecessary broad-spectrum use; consider blood product support if indicated; manage glucose, renal function, and organ support as appropriate.

Special considerations: In pediatric patients, dosing and goals differ. In resource-limited settings, follow local guidelines. The Surviving Sepsis Campaign guidelines provide bundles for recommended timing of care, though specific targets may vary. Ongoing reassessment and de-escalation are key to optimal outcomes.