Surviving Sepsis 2021 – Septic Shock Update

Spoon Feed
Here are the important updates for 2021 since the 2016 Surviving Sepsis guidelines were released.

Why does this matter?
People seem to have a love/hate relationship with Surviving Sepsis (ok maybe mostly hate). Love it or hate it, a lot of people follow these guidelines. So, what’s the latest?

Surviving this summary
Here are the major changes.

30 mL/kg fluid bolus – This was downgraded to “suggest” not recommend due to the paucity of high quality evidence for this point.

Balanced fluid – Now balanced fluids are suggested to be given rather than the 2016 version, which said either balanced or NS could be used.

Peripheral pressors – This is now suggested to be done until central access can be obtained.

No IV Vitamin C – We have covered so many of these sepsis cocktail articles. This does not benefit patients. The guidelines spell this out.

Favoring hydrocortisone – “For adults with septic shock and an ongoing requirement for vasopressor therapy we suggest using IV corticosteroids.” In 2016, steroids were not to be given if fluids and pressors achieved adequate MAP. Now, the authors favor steroids if ongoing pressors are needed. They cite ADRENAL and APROCCHSS. ADRENAL showed lower ICU days but more side effects. APROCCHSS showed lower 90-day mortality.

Focus on post-ICU – It’s not just surviving sepsis. There are serious physical, cognitive, and emotional effects for those who do survive. There is a renewed focus on follow up and care post-ICU. Also, what we do in the ICU with delirium, sedation, and mobility has a big impact on post-ICU.

Source
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-e1143. doi: 10.1097/CCM.0000000000005337.

Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021 Nov 1;49(11):1974-1982. doi: 10.1097/CCM.0000000000005357.

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