📋 Sepsis-3 Definitions (Singer et al. JAMA 2016)
Sepsis
Life-threatening organ dysfunction
Caused by dysregulated host response to infection
SOFA score ≥2 (acute change)
qSOFA ≥2 = high risk outside ICU
Septic Shock
Sepsis + hemodynamic failure
Vasopressors to maintain MAP ≥65
Lactate >2 mmol/L despite adequate resuscitation
Hospital mortality >40%
qSOFA Criteria (≥2 = high risk)
RR ≥22 breaths/min
Altered mentation (GCS <15)
SBP ≤100 mmHg
SOFA Components
Respiration: PaO₂/FiO₂
Coagulation: Platelets
Liver: Bilirubin
Cardiovascular: MAP/vasopressors
CNS: GCS | Renal: Creatinine
⚡ Hour-1 Bundle (Surviving Sepsis Campaign 2018/2021)
1
Measure
Lactate
Remeasure if >2
2
Blood Cultures
×2 sets before
antibiotics
3
Broad-spectrum
Antibiotics
within 1 hour
4
30 mL/kg
IV Crystalloid
if hypotensive/lactate ≥4
💧 Fluid Resuscitation
1
30 mL/kg IV crystalloid (NS or LR) within 3h
2
Reassess frequently — dynamic fluid responsiveness testing (PLR, PPV, SVV)
3
Prefer balanced crystalloids (LR, PlasmaLyte) over NS in septic shock
4
Albumin 4–5% if substantial crystalloid already given
5
Target: UO ≥0.5 mL/kg/h, lactate clearance ≥10%/2h
💊 Vasopressor Algorithm
1
Norepinephrine first-line
0.01–3 mcg/kg/min
2
Add Vasopressin 0.03–0.04 U/min to spare norepi (≥0.25 mcg/kg/min)
3
Add Epinephrine for persistent hypotension
4
Hydrocortisone 200 mg/day IV if refractory shock (≥0.25 mcg/kg/min norepi)
5
Target: MAP ≥65 mmHg (65–80 in elderly/CAD)
⚠️ Critical Points
●Antibiotics within 1 hour — every hour delay increases mortality by ~7%
●Source control within 6–12 hours (surgical drainage, line removal)
●Avoid dopamine in septic shock — higher arrhythmia risk (SOAP-II trial)
●Target glucose 140–180 mg/dL with insulin infusion protocol
●DVT prophylaxis, stress ulcer prophylaxis, early enteral nutrition
●Procalcitonin-guided de-escalation — reassess at 72h and narrow spectrum