Adult patients experiencing sepsis with hypotension but who did not meet the definition of septic shock received a median of 800 mL of intravenous fluid prior to initiation of norepinephrine 0.05 mcg/kg/min as a non-titratable infusion. Patients in this early vasopressor group had much lower odds of failing to achieve their primary outcome of adequate mean arterial pressure and tissue perfusion when early norepinephrine was provided.
In this systematic review and meta-analysis of randomized, controlled trials comparing administration of corticosteroids with placebo or standard supportive care in sepsis, corticosteroids were associated with reduced 28-day mortality.
This article addresses the pathophysiology, discusses various clinical presentations, and reviews current evidence-based practices for managing adrenal insufficiency and crisis in the emergency department.
In an observational study conducted at an academic medical center in London, researchers looked at factors involved in decision-making. The presumptive diagnosis of infection by the emergency department (ED) influenced decision-making by both medical and surgical admitting teams. Medical teams tended to use a multidisciplinary approach to antibiotic decision-making. Surgical teams often delegated antibiotic decision-making to the most junior members of the surgical team.
When the Severe Sepsis and Septic Shock Early Management Bundle was used to identify patients with severe sepsis or patients in septic shock, delays in lactate measurements for patients with abnormal lactate levels were associated with delayed initiation of antibiotic therapy and increased mortality.
The Infectious Diseases Society of America withheld its support for the Surviving Sepsis guidelines. The general concerns included vagueness and inconsistency in definition of sepsis, “one size fits all” prescription of time to administer antibiotics, lack of clarity around drawing blood cultures through IV catheters, recommendation of combination antibiotics, lack of definition around when to use procalcitonin levels, when and how to use pharmacokinetic and pharmacodynamic data effectively, prolonged antibiotic “prophylaxis,” and duration of therapy.
A meta-analysis that included 38 studies found the SIRS criteria had a higher sensitivity than qSOFA in predicting short-term mortality from sepsis. SIRS criteria remain useful as a screening tool for sepsis and as a prompt to initiate diagnostic work-up and treatment.
Pediatric sepsis is a high-stakes diagnosis that requires vigilance to make an early, timely diagnosis. Aggressive resuscitation, including fluids, antibiotics, and vasoactive agents, may be necessary. Rapidly changing standard of care also makes sepsis a critical diagnosis for clinicians.