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Sepsis 2021 international guidelines

Presentation · January 2022

DOI: 10.13140/RG.2.2.33245.54244

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Mohd Saif Khan

Rajendra Institute of Medical Sciences
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In
Surviving Sepsis Campaign Timeline
The SSC first published guidelines for the
management of severe sepsis and septic 2004 1st
shock
2nd
2008

2012 3rd

4th 2016

2021 5th
Recommendations
 Lower-
High-resource
resource
settings
settings
Definition of sepsis
Six SSC adult guidelines working groups:

Screening and Goals of care and

Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes
Lets sail through
Sepsis 2021 guidelines
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation We recommend that outcomes

hospitals and hospital

systems have a
21
performance 14 12 16 20
improvement program for
sepsis, including
sepsis screening for
acutely ill, high-risk
patients (BPS).

Damiani E, Donati A, Serafini G, Rinaldi L, Adrario E, Pelaia P, Busani S, Girardis M. Effect of performance improvement
programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies.
PloS one. 2015 May 6;10(5):e0125827
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes

21 14 12 16 20
?
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes

12 16 20
21 14
?
 AUROC
Machine
0.89
learning
SIRS 0.7
MEWS 0.5
SOFA 0.78
 Resuscitation

Screening and Goals of care and

Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes

16
14
 ICU

Admission

?14 For adults with sepsis or

septic shock who require ICU
admission, we suggest
admitting the patients to the
ICU within 6 h
 The guidelines now stratify antimicrobial timing
Screening and Antimicrobial should recommendations based on Goals the likelihood
of care andof
Additional
initial Infection Hemodynamics
be administered <1 h Ventilationsepsis and presence
therapies of shock
long-term
resuscitation outcomes

21 14 12 16
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation
therapies
long-term
resuscitation outcomes
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation
therapies
long-term
resuscitation outcomes
Infection
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation
therapies
long-term
resuscitation outcomes
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes

?14
 HFNC vs NIV
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes

?14
 Low tidal volume ventilation
strategy with limitation of
plateau pressure

Prone positioning

Suggest using traditional recruitment maneuvers

(recommend against an incremental PEEP strategy)

?Liberal versus conservative

oxygen targets
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes

?14 16
Screening and Goals of care and
Additional
initial Infection Hemodynamics Ventilation long-term
therapies
resuscitation outcomes

14 16
 Blood purification??
Screening and
initial Infection Hemodynamics Ventilation
Additional
Goals of care and
long-term
therapies
resuscitation outcomes
 Ulcer &Infection
Screening and
initial
thrombusHemodynamics Ventilation
Additional
Goals of care and
long-term
therapies
resuscitation outcomes
Screening and
initial
AKIInfection
& RRT Hemodynamics Ventilation
Additional
Goals of care and
long-term
therapies
resuscitation outcomes
Screening and
initial
Glucose
Infection Hemodynamics Ventilation
Additional
Goals of care and
long-term
therapies
resuscitation outcomes
Screening and
initial
NaHCO
Infection 3 Hemodynamics Ventilation
Additional
Goals of care and
long-term
therapies
resuscitation outcomes
Screening and
initial
EN
Infection Hemodynamics Ventilation
Additional
Goals of care and
long-term
therapies
resuscitation outcomes
 Less
14
emphasis
 Sepsis

Education

?14
 ICU

Handover

?14
 ICU

Discharge

?14
?14
 ICU

Follow-up

?14
Conclusion
• Very few strong recommendations
• More areas of research identified.
• Applicable even in low resource settings
• Focus on post ICU discharge planning and long term oputcome
• They believe that the 2021 SSC guidelines will foster the delivery of
best practices for sepsis evaluation and management, as well as
highlight aspects of management where additional evidence is
needed most urgently.
 Thank you

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