Management of sepsis
It is convenient to divide sepsis management into the initial resuscitation phase and the management phase.
In 2004 the “Surviving Sepsis Campaign” (SSC) sought to both raise the profile of Sepsis syndrome and to standardise treatment with a 6-hour “Resuscitation Bundle” and a 24-hour “Management Bundle”. An outline of these bundles is shown below in figure 3.
Figure 3: Surviving Sepsis Campaign (SSC) 6 and 24 hour bundles
Initial Resuscitation (First 6 hours)
As with all critically unwell patients an ABCDE approach is recommended.
- Assessment of a patient’s airway and breathing
- Supplemental oxygen given
- Prompt fluid resuscitation
- Early administration of appropriate antibiotics with source control if indicated
These interventions form the cornerstone of the initial management of sepsis as they are are time critical and have a direct bearing on outcome. It is recommended that:
- Antibiotics are administered within 3 hours of emergency department (ED) admission and within 1 hour of non-ED admission.
- Blood and other appropriate cultures should be sent prior to administration of antibiotics. The choice of antibiotics given will depend on the nature of the infection and local policy.
- An anatomical site of infection or other diagnosis should be established within the first 6 hours. If the infection is amenable to source control e.g. drainage or debridement then the appropriate expert help should be sought.