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Septic Shock Protocols

Sepsis is a serious medical condition that occurs when the blood is infected with microorganisms, usually bacteria or fungi, which causes shock and organ damage in severe cases. There are several varieties of recognized medical protocols for sepsis, although the Surviving Sepsis Campaign, published in 2004 and later revised in 2008, is a one of the most commonly used in hospitals in the United States, Europe and South America. A review study published in 2009 in the "Intensive Care Medicine Journal" indicates that hospitals that followed the campaign protocols for two or more years between 2005 and 2008 experienced a significant decrease in sepsis mortality rates.

  1. Initial Resuscitation

    • In the Surviving Sepsis Campaign there are two "bundles" of treatment regimens to be completed within the first 6 and 24 hours. The first bundle, initial resuscitation, involves measuring vitals and treating the acute symptoms caused by septic shock. The concentration of lactate in the blood, blood pressure and blood oxygen saturation are determined. The site of infection should be identified and two or more blood cultures should be obtained in order to identify the cause of the sepsis, although this step can be avoided if doing so will delay treatment. Sepsis, and the low blood pressure and low oxygen saturation that it results in, can all cause increased plasma lactate levels. If low blood pressure and high lactate levels (more than 4 millimoles of lactate per liter of blood) occur, they are treated with a saline intravenous infusion. Vasopressors (drugs used to constrict blood vessels, and the drug dobutamine may also be used to help increase blood pressure. Steroid therapy may be used if the patient does not respond well to the vasopressors and dobutamine. A transfusion of red blood cells may be used to increase oxygen saturation levels.

    Resuscitation Goals

    • There are several minimum endpoints that should be achieved during the first six hours in order to stabilize the patient. For blood pressure, the central venous pressure (the amount of blood returning to the right side of heart after it has circulated once through the body) should be 8 to 12 millimeters of mercury (mmHg) or greater, and the mean (average) arterial pressure should be 65 mmHg or greater. The central venous red blood cell oxygen saturation should be 70 percent or greater.

    Second Treatment Bundle

    • The second treatment bundle includes procedures that should be completed within the first 24 hours of treatment. The cause of infection should be identified and treated, usually with broad-spectrum antibiotics if the cause of sepsis is due to bacterial infection. Infected tissues should be analyzed using imaging studies and surgery should be performed if required to prevent the spread of infection. There are several other procedures that may be required, depending on the type and severity of the infection, such as insulin treatment for high blood sugar levels, hemodialysis if kidney function decreases, etc.

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