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The Surviving Sepsis Campaign issued new guidelines on management of sepsis and septic shock last week.

This fourth edition of the guidelines (updating the 2004, 2008, and 2012 editions) was published in Critical Care Medicine (free) and Intensive Care Medicine(subscription required) on Jan. 18. A number of related articles were published in these and other journals.

A viewpoint published by JAMA on Jan. 19, coauthored by a coauthor of the guidelines, summarized some of the most significant changes. Early goal-directed therapy is no longer recommended and is to be replaced by hemodynamic assessment for further fluid administration after the initial fluid bolus, the viewpoint noted. The new guidelines also favor use of dynamic variables to predict fluid responsiveness, the viewpoint noted. The guidelines recommend antibiotic administration as soon as possible, within an hour at most, and offer advice on whether to use combination antibiotic therapy depending on whether patients have sepsis or septic shock, the viewpoint noted. Updated bundles for sepsis care based on the guidelines will be released later this year, according to the viewpoint. 

A guideline synopsis, also in JAMA, highlighted additional recommendations, including that clinicians should assess patients daily for potential de-escalation of antimicrobials and use norepinephrine as the first-choice vasopressor, and that hospitals and health systems should implement programs to improve sepsis care that include sepsis screening. 

A users' guide to the guidelines, written by three guideline coauthors and published in Critical Care Medicine, offered advice for clinicians working to implement the guidelines. In addition to explanatory flowcharts, the guide offered reassurance that “antibiotic administration within an hour of diagnosis of sepsis is a lofty goal of care, judged to be ideal for the patient but not yet standard care” and that sepsis patients “still benefit from the art of medicine, which includes interpretation of data and individualization of treatment.” 

The guidelines were developed by a committee of 55 international experts representing 25 international organizations who were divided up to focus on five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Overall, they developed 93 statements on early management and resuscitation of patients with sepsis or septic shock—32 strong recommendations, 39 weak recommendations, and 18 best-practice statements.