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