Sepsis

qSOFA

high score = high risk

• GCS < 15
• breathing frequency >= 22/min
• systolic bp ≤ 100 mmHg

Early management

• i.v. volume and circulatory support, MAP >= 65 mmHg
• get samples
• start empiric antibiotics
  • first doses is a normal dose, even in renal failure
  • aim for application within max. 30 minutes!
• central venous catheter, arterial catheter
• treat the focus (change lines/catheter, surgery, etc…)

Volume management

• Isotonic crystalloids:
  • 30 ml/kg KG in hypotension and lactate >= 4 mmol/l
    • the administration of large amounts of fluid is suggested by various guidelines. There are however studies showing increased mortality. This article on litfl has an overview on some studies.
  • careful administration in heart failure
• Circulatory support
  • Noradrenaline: first choice, the maximum rate of 1.5 mg/h is sometimes exceeded
  • Vasopressin: higher risk for ischemia, common dose 0.03 units/h
  • Dobutamine: inotropic, consider in heart failure, 150 - 600 µg/kg weight/h
  • Adrenaline: inotropic

Further considerations

• consider steroids if high circulatory support is needed
  • e.g. 200 mg hydrocortisone
• dialysis in acute renal failure
• intubation with sedation in respiratory failure
• transfusion with Hb < 7 g/dl
• nutrition
  • start when hemodynamic stability is reached
  • don’t lower blood glucose too aggressively, aim for 140 - 180 mg/dl,

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