The Surviving Sepsis Guidelines were first published in 2004, with updates issued in 2008 and 2012. In January, the newest updates were released and published in Critical Care Medicine and Intensive Care Medicine.
The new guidelines were written by a committee of 55 experts representing 25 international organizations. They provided 93 recommendations on early management of sepsis and septic shock.
Here are five things to know about the major changes in the new update.
1. The most important changes came in the areas of antibiotic therapy and initial resuscitation, according to a January JAMA article.
2. The new initial resuscitation guidelines now recommend using hemodynamic assessment for further fluid administration as well as for determining the type of shock if the clinical diagnosis does not lead to clear diagnosis. Previously, initial resuscitation guidelines were based on early goal-directed therapy, which is no longer recommended.
3. New guidelines recommending using dynamic over static variables to predict fluid responsiveness. "This is a significant change," according to the JAMA article. "The guidelines moved from a protocolized, quantitative resuscitation strategy to a more patient-centered resuscitation approach guided by hemodynamic assessment including dynamic variables for fluid responsiveness and ongoing reevaluation of the response to treatment."
4. The updated guidelines call for antibiotics to be administered as soon as possible within one hour, as studies show delay in antibiotic treatment can lead to increased risk of death.
5. The new guidelines also address combination therapy, or using two different classes of antibiotics to cover a pathogen sensitive to both. Doing so is not recommended for routine treatment of neutropenic sepsis, but it can be done with patients who are in septic shock.