Guidelines Quality and Patient Safety Sepsis Surviving Sepsis Campaign

Surviving Sepsis Campaign Guidelines 2021

PUBLISHED: 10/03/2021

Surviving Sepsis Campaign Guidelines 2021

Citation: Critical Care Medicine: October 4, 2021

International Guidelines for Management of Sepsis and Septic Shock 2021

Updated global adult sepsis guidelines, released in October 2021 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 new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often 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.

Guideline Type: Clinical

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Video: SSC Adult Guidelines 2021: What's New and What's Changed?
Members of the Surviving Sepsis Campaign Guidelines Taskforce discuss the new and modified recommendations for adult patients with sepsis and septic shock, released in October 2021.

Learning Slides: 2021 Surviving Sepsis Guidelines
Download slides with an overview of the development and recommendations from the guidelines.

Podcast: SSC: International Guidelines for Management of Sepsis and Septic Shock 2021 – ESICM Talk
In this episode of the ESICM Talk, powered by the ICM Journal, Manu Shankar-Hari, ICM Associate Editor, interview Laura Evans and Andrew Rhodes, among the authors of the updated Surviving Sepsis Campaign adult guidelines.

Blog: Surviving Sepsis Campaign Releases 2021 Adult Sepsis Guidelines
Read about the release of the guidelines in this SCCM blog.

Critical Care Medicine Article: The Evolution of Toolkits and Bundles to Improve the Care of Sepsis Patients
Read this foreward from Critical Care Medicine on the evolution of toolkits and bundles in sepsis care.

Translations

Surviving Sepsis Campaign Hour-1 Bundle

The hour-1 bundle should be viewed as a quality improvement opportunity moving toward an ideal state. For critically ill patients with sepsis or septic shock, time is of the essence. Although the starting time for the Hour-1 bundle is recognition of sepsis, both sepsis and septic shock should be viewed as medical emergencies requiring rapid diagnosis and immediate intervention.

The hour-1 bundle encourages clinicians to act as quickly as possible to obtain blood cultures, administer broad spectrum antibiotics, start appropriate fluid resuscitation, measure lactate, and begin vasopressors if clinically indicated. Ideally these interventions would all begin in the first hour from sepsis recognition but may not necessarily be completed in the first hour. Minimizing the time to treatment acknowledges the urgency that exists for patients with sepsis and septic shock.

*Note that the description of the hour-1 bundle above is the most current description, having passed all approval points effective October 10, 2019.

SSC Hour-1 Bundle of Care Elements:

Measure lactate level*
Obtain blood cultures before administering antibiotics.
Administer broad-spectrum antibiotics.
Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate level ≥ 4 mmol/L.
Apply vasopressors if hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg.

* Remeasure lactate if initial lactate is elevated (> 2 mmol/L).

Read Full Guideline

We make no recommendation on the use of antiviral agents.

Infection No Recommendation Antiviral Therapy

There is insufficient evidence to make a recommendation on the use of restrictive versus liberal fluid strategies in the first 24 hours of resuscitation in patients with sepsis and septic shock who still have signs of hypoperfusion and volume depletion after the initial resuscitation.

Hemodynamic Management No Recommendation Fluid Resuscitation

There is insufficient evidence to make a recommendation on the use of conservative oxygen targets in adults with sepsis-induced hypoxemic respiratory failure.

Ventilation No Recommendation O2 Targets

There is insufficient evidence to make a recommendation on the use of noninvasive ventilation compared to invasive ventilation for adults with sepsis-induced hypoxemic respiratory failure.

Ventilation No Recommendation Noninvasive Ventilation

There is insufficient evidence to make a recommendation on the use of other blood purification techniques.

Additional Therapies No Recommendation Blood Purification

For adults with sepsis or septic shock, there is insufficient evidence to make a recommendation on any specific standardized criterion to trigger a goals-of-care discussion.

LTO-GOC No Recommendation Goals of Care

For adults with sepsis or septic shock, there is insufficient evidence to make a recommendation on the use of any specific structured handoff tool over usual handoff processes.

LTO-GOC No Recommendation Transitions of Care

For adults with sepsis or septic shock and their families, there is insufficient evidence to make a recommendation on early post-hospital discharge follow-up compared with routine post-hospital discharge follow-up.

LTO-GOC No Recommendation Discharge Planning

For adults with sepsis or septic shock, there is insufficient evidence to make a recommendation for or against early cognitive therapy.

LTO-GOC No Recommendation Cognitive Therapy

A complete list of the guidelines authors and contributors is available within the published manuscript.

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