Create ppt sepsis management with recent guidelines
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Surviving Sepsis Campaign 2024 2025 guidelines updates
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sepsis management guidelines 2025 hour-1 bundle antibiotics fluids vasopressors
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Sepsis Management Guidelines 2025
Presentation · PPTX
What's Inside — 16 Slides
| Slide | Topic |
|---|---|
| 1 | Title Slide — bold navy/crimson design |
| 2 | Agenda / Overview |
| 3 | Definitions — Sepsis-3 (Infection → Sepsis → Septic Shock) |
| 4 | Epidemiology — 48.9M cases/yr, global burden stats |
| 5 | Pathophysiology — cytokine storm, endothelial dysfunction, MOF cascade |
| 6 | Diagnosis & Screening — qSOFA, SOFA score table |
| 7 | The 1-Hour Bundle (SSC) — 5-step visual layout |
| 8 | Antimicrobial Therapy — empiric selection table by scenario |
| 9 | Fluid Resuscitation — ROSE phases (Rescue → Optimise → Stabilise → Evacuate) |
| 10 | Vasopressors — step-up table (NE → Vasopressin → Epi → Ang-II → Dobutamine) |
| 11 | Source Control — imaging, procedural, surgical, device removal |
| 12 | Adjunctive Therapies — steroids, glucose, VTE, Vit C (not recommended), RRT |
| 13 | Mechanical Ventilation — lung-protective, prone positioning, HFNO, ECMO |
| 14 | Post-ICU Recovery — Post-Sepsis Syndrome (cognitive, physical, psychological) |
| 15 | Clinical Pearls — 8 key takeaways |
| 16 | References — SSC 2021, SSC Children 2026, Harrison's 22e, S3 Guidelines 2025, PADIS 2025 |
Key guidelines incorporated:
- Surviving Sepsis Campaign Adult Guidelines 2021
- SSC Children's Guidelines 2026 (PMID 41869844)
- S3 Sepsis Guidelines Update 2025 (Germany, PMID 40824313)
- PADIS 2025 ICU sedation update (PMID 39982143)
- Harrison's Principles of Internal Medicine 22e (2025)
- CMS SEP-1 Bundle current version
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Here are your 8 Sepsis Management Flashcards based on the SSC 2021 guidelines. Here's what each card covers:
| # | Question | Key Answer |
|---|---|---|
| 1 | Sepsis-3 definition of Sepsis | SOFA ≥ 2 + dysregulated host response |
| 2 | Definition of Septic Shock | Vasopressor to maintain MAP ≥ 65 + Lactate > 2 |
| 3 | 3 components of qSOFA | RR, AMS, Systolic BP |
| 4 | SSC 1-Hour Bundle (5 elements) | Lactate, Cultures, ABx, Fluids, Vasopressors |
| 5 | First-line vasopressor | Norepinephrine + add Vasopressin at escalating doses |
| 6 | When to start corticosteroids | Refractory shock despite fluids + vasopressors |
| 7 | Preferred fluid type & dose | Balanced crystalloid, 30 mL/kg in 3 hrs |
| 8 | Antibiotic timing | Septic shock: 1 hr / Sepsis without shock: 3 hrs |
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Here are concise notes on Sepsis Management based on SSC 2021 guidelines and recent evidence:
SEPSIS MANAGEMENT — CONCISE NOTES
Surviving Sepsis Campaign 2021 | Harrison's 22e | SSC Children 2026
1. DEFINITIONS (Sepsis-3, 2016)
| Term | Definition |
|---|---|
| Sepsis | Life-threatening organ dysfunction from dysregulated host response to infection. SOFA ≥ 2 from baseline |
| Septic Shock | Sepsis + vasopressor needed to maintain MAP ≥ 65 mmHg + Lactate > 2 mmol/L despite fluids |
| qSOFA | RR ≥ 22 + GCS < 15 + SBP ≤ 100. Score ≥ 2 = poor prognosis |
2. THE 1-HOUR BUNDLE (SSC 2018 update)
All elements initiated simultaneously from time zero:
- Lactate — measure baseline; remeasure in 2–4 h if > 2 mmol/L
- Blood cultures × 2 sets before antibiotics (don't delay ABx > 45 min)
- Broad-spectrum antibiotics — within 1 h (septic shock) / 3 h (sepsis, uncertain dx)
- Crystalloid 30 mL/kg — if hypotensive OR lactate ≥ 4 mmol/L
- Vasopressors — start if MAP < 65 mmHg during/after fluids
3. ANTIMICROBIALS
- Cover all likely organisms empirically; narrow once cultures return
- No Pseudomonas risk → Ceftriaxone/Cefotaxime
- Pseudomonas risk → Cefepime / Pip-Tazo / Carbapenem
- MRSA risk → add Vancomycin
- MDR gram-negative → Ceftazidime-Avibactam
- Immunocompromised → broad + antifungal
- Duration: 7–10 days; shorter if rapid improvement
- Procalcitonin — use to guide STOPPING, NOT starting
- Prolonged infusion of beta-lactams preferred over bolus (weak rec)
4. FLUID RESUSCITATION
| Phase | Goal | Action |
|---|---|---|
| Rescue | Restore perfusion | 30 mL/kg balanced crystalloid |
| Optimise | Haemodynamic stability | Dynamic assessment (PLR, PPV, POCUS) |
| Stabilise | Prevent fluid overload | Conservative strategy; serial lactates |
| Evacuate | De-resuscitate | Diuretics/CRRT if needed |
- Balanced crystalloids (LR, Plasmalyte) > 0.9% NaCl — reduces AKI
- Albumin — consider if large crystalloid volumes needed (no proven mortality benefit)
- Avoid hetastarch (HES) — increased AKI and mortality
5. VASOPRESSORS
| Step | Agent | Dose | Notes |
|---|---|---|---|
| 1st line | Norepinephrine | 0.01–3 μg/kg/min | Target MAP ≥ 65 mmHg |
| Add-on | Vasopressin | Fixed 0.03 U/min | Add when NE ≥ 0.25 μg/kg/min |
| Add-on | Epinephrine | 0.01–0.5 μg/kg/min | Useful in low cardiac output |
| Refractory | Angiotensin II | 20–200 ng/kg/min | Reduces NE requirement |
| Inotrope | Dobutamine | 2–20 μg/kg/min | Add for persistent low CO |
- MAP 65 is sufficient — higher targets don't improve survival
- Peripheral vasopressors are safe — don't delay for central access
- Avoid dopamine routinely (higher arrhythmia risk)
6. SOURCE CONTROL
- Identify source with imaging (CT/USS/Echo) — promptly
- Drain abscesses; debride necrotic tissue; remove infected devices
- Timing: within 6–12 hours of sepsis recognition
- Delayed source control = independent predictor of mortality
7. ADJUNCTIVE THERAPIES
| Therapy | Recommendation | Details |
|---|---|---|
| Corticosteroids | Weak rec — if refractory shock | Hydrocortisone 200 mg/day IV |
| Glucose control | Best practice | Insulin if BG > 180; target 144–180 mg/dL |
| VTE prophylaxis | Strong rec | LMWH preferred; IPC if anticoagulation contraindicated |
| Stress ulcer PX | Weak rec | PPI/H2B if GI bleeding risk factors present |
| Blood transfusion | Restrictive | Transfuse only if Hb < 7 g/dL; target 7–9 g/dL |
| Vitamin C | NOT recommended | No mortality benefit (CITRIS-ALI, LOVIT trials) |
| IV Immunoglobulin | Not suggested | No consistent benefit |
| RRT | AKI-guided | CRRT preferred in haemodynamic instability |
8. MECHANICAL VENTILATION (Sepsis-ARDS)
- Tidal volume: 6 mL/kg IBW (max 8)
- Plateau pressure: ≤ 30 cmH₂O; Driving pressure < 15
- PEEP: apply using PEEP-FiO₂ table
- Prone positioning: ≥ 12–16 h/day for moderate-severe ARDS (P/F < 150)
- HFNO: consider before intubation in hypoxic respiratory failure
- ECMO: for refractory ARDS at experienced centres
- Sedation: light sedation (RASS −1 to 0); propofol/dexmedetomidine over benzos
- Avoid routine pulmonary artery catheter
9. POST-SEPSIS SYNDROME
Affects 25–50% of survivors:
- Cognitive: memory loss, attention deficits, PTSD
- Physical: ICU-acquired weakness, neuropathy — early physiotherapy
- Psychological: depression, anxiety — psychiatric follow-up
- SSC 2021/2024: involve patients and families in goals-of-care and discharge planning
- Follow-up clinic at 1 month and 3 months post-discharge
10. CLINICAL PEARLS
⏱ Every 1-hour delay in antibiotics = 7–8% increase in mortality (septic shock)
- Always cultures before antibiotics — but never delay ABx > 45 min for cultures
- 30 mL/kg is a starting point — always reassess fluid responsiveness dynamically
- Peripheral NE is safe — do NOT wait for central access
- De-escalate antibiotics once cultures available
- Source control cannot be replaced by antibiotics — find and drain
- Post-sepsis rehabilitation planning starts from day 1 in the ICU
Sources: SSC 2021 Adult Guidelines | SSC Children 2026 (PMID 41869844) | S3 Guidelines 2025 (PMID 40824313) | Harrison's Internal Medicine 22e (2025) | PADIS 2025 (PMID 39982143)
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Sepsis Quick Reference
PDF Document · PDF
What's in the PDF
A clean, print-ready A4 document with 10 colour-coded sections:
| Section | Content |
|---|---|
| 01 | Definitions table — Sepsis, Septic Shock, qSOFA |
| 02 | 1-Hour Bundle — all 5 elements with details |
| 03 | Antimicrobial therapy table by clinical scenario |
| 04 | Fluid resuscitation — ROSE framework table |
| 05 | Vasopressor step-up ladder with doses |
| 06 | Source control — bullet checklist |
| 07 | Adjunctive therapies table (steroids, VTE, glucose, RRT, Vit C) |
| 08 | Mechanical ventilation targets for ARDS |
| 09 | Post-Sepsis Syndrome domains and interventions |
| 10 | 8 Clinical Pearls in highlighted navy boxes |
Designed for printing and pinning at the bedside or ICU workstation. Page numbers, a crimson header stripe, and full source citations are included at the bottom.
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