Sepsis

The International Surviving Sepsis Campaign has developed guidelines for sepsis treatment. Resources 1 and 2 represent the guidelines and an accompanying pocket guide, respectively. Resource 3 is a poster with the full guidlines. Resources 4 and 5 present the latest opinion on steroid usage in sepsis. Additional information is at the Surviving Sepsis Campaign web site.

1. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Critical Care Medicine. 2008;36(1):296-327.
2. 2008 Surviving Sepsis Campaign Pocket Guide, as distributed by the European Society of Intensive Care Medicine. (free full access).
3. 2008 Surviving Sepsis Campaign Poster. (free full access).
4. Annane D, Bellissant E, Bollaert P, et al. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review. JAMA: the journal of the American Medical Association. 2009;301(22):2362-75. Recommendations summary: “Corticosteroids should be considered at a daily dose of 200 to 300 mg of hydrocortisone (or equivalent) as intravenous bolus or continuous infusion. Although evidence is not particularly robust, we suggest that treatment should be given at full dose for at least 100 hours and only in adults with vasopressor-dependent septic shock. There is insufficient evidence from this meta-analysis to support either a gradual or an abrupt interruption of treatment.”
5. Jaeschke R, Angus DC. Living with uncertainty in the intensive care unit: should patients with sepsis be treated with steroids? JAMA: the journal of the American Medical Association. 2009;301(22):2388-90.

Implementation Examples

Loma Linda University

1. Stop Sepsis Bundle Toolkit. (free full access).
2. Slide presentation describing adoption. (free full access).
3. Nguyen HB, Lynch EL, Mou JA, et al. The utility of a quality improvement bundle in bridging the gap between research and standard care in the management of severe sepsis and septic shock in the emergency department. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. 2007;14(11):1079-86. (free full access).

Los Angeles County

The following documents represent the algorithm and order sets used in teaching and across the Los Angeles County System. Pages 1, 3, and 4 of the order set are used across the system. Page 2 is facility-specific based on the facility's antibiotic selection. Page 1 initiates the sepsis consideration and is used on anyone that requires blood cultures drawn. Page 2 is facility specific antibiotic selection in severe sepsis based on suspected infection site. Page 3 and 4 are the Early Goal Directed Therapy (EGDT) components.

1. Treatment flow diagram. (free full access).
2. Order set, page 1. (free full access).
3. Order set, page 2. (free full access).
4. Order set, page 3. (free full access).
5. Order set, page 4. (free full access).