Sepsis

Sepsis is a whole-body inflammatory response to an infection.[1] Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.[2] There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection. In the very young, old, and people with a weakened immune system, there may be no symptoms of a specific infection and the body temperature may be low or normal rather than high.[3] 

Sepsis is caused by an immune response triggered by an infection.[3][4] The infection is most commonly by bacteria, but can also be by fungi, viruses, or parasites.[3] Common locations for the primary infection include: lungs, brain, urinary tract, skin, and abdominal organs. Risk factors include young or old age, a weakened immune system from conditions such as cancer or diabetes, and major trauma or burns.[2]


ESICM & Sepsis

Updated Adult Guidelines – October 2021

The updated adult sepsis guidelines represent input from a diverse panel of 60 experts and a survey of more than 800 intensivists from more than 30 countries. The guidelines recommend involving patients and their families in goals-of-care discussions to treat the long-term effects of sepsis.

Guidelines Access

Update January 2021: COVID-19 guidelines 

The Surviving Sepsis Campaign (SSC) has updated the previously released Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).

The panel issued nine statements related to ICU patients with severe or critical COVID-19. Several of the original recommendations remain current.

Amongst the nine updates for treating severe or critical COVID-19 patients, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis, and strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma outside clinical trials. The SSC COVID-19 panel suggests using remdesivir in nonventilated patients with severe COVID-19 and suggests against starting remdesivir in patients with critical COVID-19 outside clinical trials. Because of insufficient evidence, the panel was not able to issue recommendations on the use of awake prone positioning or empiric therapeutic anticoagulation.

Guidelines Access

Access the original guidelines, published in June 2020, here.

This guideline is updated regularly as new evidence becomes available.

 

Surviving Sepsis Campaign

The European Society of Intensive Care Medicine (ESICM) alongside the Society of Critical Care Medicine (SCCM) spearheaded the Surviving Sepsis Campaign (SSC) in 2002 with several aims including the development of guidelines for diagnosis, treatment and post-ICU care of sepsis and a reduction of mortality from sepsis.

The updated guidelines are freely available in Intensive Care Medicine:

Rhodes A. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

The Guidelines have also been translated into several languages:

For more information on the SSC Campaign, please visit the Surviving Sepsis Campaign webpage.

The Surviving Sepsis Campaign Bundle: 2018 update

The Surviving Sepsis Campaign (SSC) has released a new updated Hour-1 Bundle to reflect the latest evidence from the International Guidelines for Management of Sepsis and Septic Shock 2016. Currently, there is a discussion underway amongst a number of experts with regards to this bundle. Should there be any further progress on this initiative, ESICM will provide updates as necessitated.

ESICM has released the The Surviving Sepsis Campaign Bundle: 2018 update (Free Access) in our official journal Intensive Care Medicine. Additionally, we have prepared a short animation video to highlight the five steps of the Hour-1 Bundle that healthcare providers are recommended to begin as soon as sepsis is recognised. More information and the video are available here.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2020

The Society of Critical Care Medicine and European Society of Intensive Care Medicine have announced that the 2020 update of the adult Surviving Sepsis Campaign guidelines will be completed in collaboration with the GUIDE group (Guidelines in Intensive Care, Development and Evaluation) affiliated with The Research Institute of St. Joseph’s Healthcare and McMaster University.  

 Paediatric Sepsis Guidelines published in Intensive Care Medicine and Pediatric Critical Care Medicine recommend child-specific care for deadly condition

The guidelines were developed to help improve care in children from birth to age 18. While the condition is more common in adults, 1.2 million children develop sepsis globally every year. Sepsis can be overlooked in children because low blood pressure (a sign of septic shock) may not occur until very late in the illness. For this reason, the guidelines recommend each institution implement screening and protocols to facilitate timely recognition and treatment for children with sepsis and septic shock.

The Sepsis Definitions Task Force

Definitions for sepsis and septic shock were last revised in 2001. In order to evaluate and, as needed, update definitions for sepsis and septic shock, ESICM and SCCM convened a Task Force of 19 members with expertise in sepsis pathophysiology, clinical trials and epidemiology. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases and voting, followed by circulation to international professional societies requesting peer review and endorsement. The resulting publications can be found below.

Singer M, Deutschman CS, Seymour CW, et al: The Sepsis Definitions Task Force The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Shankar-Hari M, Phillips G, Levy ML, et al. Assessment of definition and clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Seymour CW, Liu V, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).


References

1. Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup; Dellinger, RP; Levy, MM; Rhodes, A; et al. (2013). “Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012” (PDF). Critical Care Medicine 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. PMID 23353941 – via Surviving Sepsis Campaign.
2. “Sepsis Questions and Answers”. cdc.gov. Centers for Disease Control and Prevention (CDC). May 22, 2014. Retrieved 28 November 2014.
3. Jui, Jonathan (2011). “Ch. 146: Septic Shock”. In Tintinalli, Judith E.; Stapczynski, J. Stephan; Ma, O. John; Cline, David M.; et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide (7th ed.). New York: McGraw-Hill. pp. 1003–14. Retrieved December 11, 2012 – via AccessMedicine. (subscription required (help)).
4. Deutschman, CS; Tracey, KJ (April 2014). “Sepsis: Current dogma and new perspectives”. Immunity 40 (4): 463–75. doi:10.1016/j.immuni.2014.04.001. PMID 24745331.


Sepsis Publications

Coopersmith, C.M., De Backer, D., Deutschman, C.S. et al. Surviving Sepsis Campaign: Research priorities for sepsis and septic shockIntensive Care Med (2018) https://doi.org/10.1007/s00134-018-5175-z

Urayeneza, O., Mujyarugamba, P., Rukemba, Z. et al. Increasing evidence-based interventions in patients with acute infections in a resource-limited setting: a before-and-after feasibility trial in Gitwe, Rwanda. Intensive Care Med (2018). https://doi.org/10.1007/s00134-018-5266-x

Levy, M.M., Evans, L.E. & Rhodes, A.The Surviving Sepsis Campaign Bundle: 2018 update Intensive Care Med (2018). https://doi.org/10.1007/s00134-018-5085-0

Ben Andrews, Matthew W. Semler, Levy Muchemwa, et al. Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension Randomised Clinical Trial. JAMA. 2017;318(13):1233-1240. doi:10.1001/jama.2017.10913

Bloos F, Rüddel H, Thomas-Rüddel D, et al (2017) Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomised trial. Intensive Care Med 43:1602–1612. doi: 10.1007/s00134-017-4782-4

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Intensive Care Medicine – Jan 2017

Paul E. Marik, Vikramjit Khangoora, Racquel Rivera, Michael H. Hooper, John Catravas. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock – A Retrospective Before-After Study. CHEST. DOI: http://dx.doi.org/10.1016/j.chest.2016.11.036

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock, 2012 Intensive Care Medicine – Jan 2013

Singer M, Deutschman CS, Seymour CW, et al: The Sepsis Definitions Task Force The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Shankar-Hari M, Phillips G, Levy ML, et al. Assessment of definition and clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).

Seymour CW, Liu V, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). (JAMA, February 23, 2016, Vol 315, No. 8).


Sepsis Videos

How I implement the newest SSC guidelines in my ICU (Ricard Ferrer Roca, June 2018)

The Surviving Sepsis Campaign Bundle: 2018 update (ICM Pulse, May 2018)

Sepsis: Effect of a multifaceted educational intervention for anti-infectious measures on mortality (Frank Bloos, Nov 2017)

COMMENTARY – THE WHO SEPSIS RESOLUTION: Making an impact on global sepsis awareness (Ruth Kleinpell, Oct 2017)

EGDT for Sepsis care in Zambia: an RCT (Todd Rice, Sept 2017)

Sepsis Series (icTV): Impact of the Surviving Sepsis Campaign (Ricard Ferrer Roca, Jan 2015)

Sepsis Series (icTV): Performance metrics and outcomes – Results from a 7.5-year study published in ICM (Mitchell Levy, Oct 2014)

IMPRESS: Spring Update 2014 (icTV) (Mitchell Levy, March 2014)

Sepsis Series (icTV): The Next Phase of SSC (Richard Beale, 2013)

Sepsis Series (icTV): Future Outlook (Derek Angus, July 2013)

Sepsis Series (icTV): Expanding a Winning SSC Strategy (Jean-Daniel Chiche, July 2013)

Sepsis Series (icTV): What to do if you Suspect Sepsis (Rupert Pearse, 2013)

Sepsis Series (icTV): How to Implement SSC Guidelines in Your Hospital (Ricard Ferrer Roca, 2013)

Sepsis Series (icTV): SSC affects 25% reduction in mortality rates – Future Expansion & Implementation (Jean-Daniel Chiche, 2013)

Sepsis Series (icTV): Antimicrobial Therapy – The 3 Key Factors (Ricard Ferrer Roca, 2013)

Sepsis Series (icTV): How the Updated SSC Guidelines will Impact MY Practice… (Djillali Annane, 2013)

Sepsis Series (icTV): Lactates, Fluids, Antibiotics & Biomarkers (Ricard Ferrer Roca, 2013)

Sepsis Series (icTV): Utilising SSC Bundles (Richard Beale, 2013)

icTV interview with Richard Beale: SSC progress (2012)

icTV interview with Mitchell Levy: SSC updated guidelines (2012)

 

Webinars

ESICM hosts webinars focused on the definition, diagnosis, treatment and management of sepsis.