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ARTICLE

Guidelines to Caring for Patients With Sepsis: Promise or Progress?

AUG 08, 2017 | JESSICA BURCHETTE, PHARMD, BCPS, AND DAVID CLUCK, PHARMD, BCPS, AAHIVP
KEY UPDATES IN 2016 SURVIVING SEPSIS GUIDELINES
  • Emphasis remains on early and adequate fluid resuscitation for patients who meet clinical criteria for sepsis.
  • Removal of most specific EGDT end points, with greater emphasis place on patient-centric resuscitation approach.
  • Timely initiation of antimicrobials is paramount, with increased emphasis on appropriate de-escalation and antimicrobial stewardship as a key health care initiative.
The Surviving Sepsis Campaign was launched in 2002 by representatives from the Society of Critical Care Medicine and the European So­ciety of Intensive Care Medicine. The Surviving Sepsis Guidelines were published soon thereafter, in 2004, with revisions in 2008, 2012, and 2016. Moreover, as revisions occurred the definition of sepsis has con­tinued to evolve. A list of updates to the definitions is shown in the Table. Given the pervasiveness of sepsis and its associated high mortality rate, the introduction and implementation of Surviving Sepsis Campaign ini­tiatives improved patient care and decreased mortal­ity.1 The revisions to these guidelines, as new literature emerged, have undoubtedly also significantly improved patient care. Select updates to the 2012 guidelines, which are available in the 2016 version, are described herein.2

Initial resuscitation of patients with crystalline fluids continues to be a cornerstone of therapy in patients with sepsis. Perhaps the most noticeable change is the shift away from protocolized resuscitation efforts, bet­ter known as early goal-directed therapy (EGDT).3 EGDT comprises specific endpoints that should be achieved within 3 and 6 hours from the identification of sepsis, while, usual care includes fluid administration, anti­biotics and supportive care in a less formalized fash­ion. This paradigm shift is in response to findings from a trio of large randomized controlled trials: ARISE, ProCESS and ProMISe.4-6 Compared with usual care, these trials failed to demonstrate a mortality benefit when EGDT was implemented. It is worth noting that the definition and implementation of “usual care” has improved since the original EGDT trial was conducted. Moreover, in the aforementioned trials, the lack of harm when using the protocolized EGDT led to the guidelines continuing to endorse EGDT targets.


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