In November, the 4th update to the Surviving Sepsis Campaign (SSC) guidelines were published. The guidelines incorporate studies over the last 5 years on managing patients with sepsis, while also maintaining emphasis on key principles like early antibiotic administration. Some differences to highlight are:
1) Administering an initial fluid bolus of 30 mL/kg was downgraded from ‘strong’ to ‘weak’ based on the low quality of evidence (however, resuscitation should start immediately!);
2) Balanced crystalloids (like LR) should be used for resuscitation rather than normal saline – made as a ‘weak’ recommendation based on available quality of evidence, the guidelines cite an evolving recognition of potential adverse effects of NS including hyperchloremic metabolic acidosis as part of the rationale;
3) Vasopressors should be initiated peripherally if the alternative is delayed care until a central line is placed;
4) Patients with ongoing vasopressor requirements should receive intravenous corticosteroids (this recommendation was strengthened); however, administration of intravenous vitamin C is explicitly not recommended.
These changes are likely to be reflected in the Centers for Medicare & Medicaid Services (CMS) sepsis bundle measures in 2022.
References: Executive summary: Surviving Sepsis Campaign: International guidelines for the management of sepsis and septic shock 2021
