Updated global adult sepsis guidelines, released by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions. The updated guidelines are especially important today, as many who are seriously ill with COVID-19 are particularly vulnerable to sepsis.
The
Surviving Sepsis Campaign adult sepsis guidelines, published in
Critical Care Medicine, reflect best practices and recommendations for the treatment of sepsis and septic shock in adults and are revised regularly to account for new research.
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The new guidelines specially address challenges to treating patients experiencing the long-term effects of sepsis are also addressed in the guidelines. Patients often have lengthy ICU stays and then face a long and complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families often are uncertain how to coordinate care that promotes recovery and matches their goals of care.
To address these issues, the guidelines recommend involving patients and their families in goals-of-care discussions and hospital discharge plans, which should include early and ongoing follow-up with clinicians to support and manage long-term effects and assessment of physical, cognitive, and emotional issues after discharge.
“Treatment for sepsis goes beyond in-hospital care,” said Laura E. Evans, MD, MSc, FCCM, SSC adult guidelines cochair. “Many sepsis survivors experience short- and long-term consequences such as cognitive or physical disability. Ongoing recovery can take months or years. It’s essential to develop a plan to address these long-term consequences when a patient is discharged.”
Early identification remains crucial to effective sepsis treatment. A new recommendation in the guidelines is to use a performance improvement program, including a screening tool such as the Systemic Inflammatory Response Syndrome (SIRS), National Early Warning Score (NEWS) or Modified Early Warning Score (MEWS), rather than the Quick Sequential Organ Failure Assessment (qSOFA).
“The guidelines emphasize that having a systematic applied screening process is essential to recognizing patients with sepsis early,” said Waleed Alhazzani, MD, MSc, FRCPC, adult guidelines methodology chair. “If you don’t look for it, you might miss sepsis, but the clock is ticking and time matters, so patients should constantly be reevaluated for where they are and what they need next.”
Long-term treatment recommendations include:
- Discussing goals of care and prognosis with patients and families
- Integrating principles of palliative care (which may include palliative care consultation based on clinician judgement) into the treatment plan, when appropriate, to address patient and family symptoms and suffering
- Referral to peer support groups for patients and their families
- Screening for economic and social support (including housing, nutritional, financial, and spiritual support), and referrals where available to meet these needs
- Written and verbal sepsis education (diagnosis, treatment, and post-ICU/post-sepsis syndrome) before hospital discharge and in the follow-up setting
- Opportunity for the patient and family to participate in shared decision-making in post-ICU and hospital discharge planning to ensure that discharge plans are acceptable and feasible
Other guidelines recommendations include:
- Screening and early treatment of sepsis remain critical. The guidelines recommend using a performance improvement program for sepsis, including sepsis screening for acutely ill, high-risk patients and standard operating procedures for treatment.
- The guidelines suggest against using IV vitamin C for adults with sepsis or septic shock.
- The guidelines suggest starting vasopressors peripherally to restore mean arterial pressure rather than delaying initiation until central venous access is secured.
- For adults with sepsis-induced severe acute respiratory distress syndrome, the guidelines suggest using venovenous extraxorporeal membrane oxygenation when conventional mechanical ventilation fails in experienced centers with the infrastructure in place to support its use.
The updated version of the guidelines includes input from a diverse panel of 60 experts and a survey of more than 800 intensivists from more than 30 countries. The workgroup that developed the guidelines was significantly more diverse than previous workgroups, with more women, better representation from low-income countries, and more patient and family representatives. Additionally, healthcare professionals from around the world were surveyed to help the workgroup better understand and address practice variations in resource-poor areas.
“A more diverse panel of experts helps to minimize bias and ensure that the recommendations are more inclusive,” said Professor Andrew Rhodes, FRCP, FRCA, FFICM, guidelines cochair. “While much of the evidence we have on best practices to treat sepsis comes from higher-income countries, the burden of sepsis is predominantly in lower-income countries. The guidelines address resource challenges unique to lower-income countries, such as access to some medications.”
The SSC is a joint initiative of the Society of Critical Care Medicine (SCCM) and the
European Society of Intensive Care Medicine (ESICM), which are committed to reducing death and disability from sepsis and septic shock worldwide.
