MAJOR RECOMMENDATIONS

The grades of recommendations (A-E) and grades of evidence (I-V) are defined at the end of the "Major Recommendations" field.

Initial Resuscitation

 

  1. The resuscitation of a patient in severe sepsis or sepsis-induced tissue hypoperfusion (hypotension or lactic acidosis) should begin as soon as the syndrome is recognized and should not be delayed pending intensive care unit (ICU) admission. An elevated serum lactate concentration identifies tissue hypoperfusion in patients at risk who are not hypotensive. During the first 6 hrs of resuscitation, the goals of initial resuscitation of sepsis-induced hypoperfusion should include all of the following as one part of a treatment protocol:
    • Central venous pressure: 8–12 mm Hg
    • Mean arterial pressure >65 mm Hg
    • Urine output >0.5 mL/kg/hr
    • Central venous (superior vena cava) or mixed venous oxygen saturation >70%

    Grade of Recommendation B

 

  1. During the first 6 hrs of resuscitation of severe sepsis or septic shock, if central venous oxygen saturation or mixed venous oxygen saturation of 70% is not achieved with fluid resuscitation to a central venous pressure of 8–12 mm Hg, then transfuse packed red blood cells to achieve a hematocrit of >30% and/or administer a dobutamine infusion (up to a maximum of 20 micrograms/kg/min) to achieve this goal.

    Grade of Recommendation: B