Lecture on Sepsis – an update

This is the screen cast of a lecture titled “Sepsis an update” given by Irfan Hafiz MD on June 21st 2013 at Centegra Woodstock Hospital.

Sepsis protocol


  1. Measure lactate level
  2. Obtain blood cultures prior to administration of antibiotics
  3. Administer broad spectrum antibiotics
  4. Administer 30 ml/kg crystalloid for hypotension or lactate ≥4mmol/L


  1. Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65 mm Hg
  2. In the event of persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥4 mmol/L (36 mg/dL):
    1. Measure central venous pressure (CVP)*
    2. Measure central venous oxygen saturation (ScvO2)*
  3. Remeasure lactate if initial lactate was elevated*
  4. Targets for quantitative resuscitation included in the guidelines are CVP of ≥8 mm Hg; ScvO2 of ≥70%, and normalization of lactate.

Resuscitation Goals

  1. To achieve central venous pressure (CVP) of > 8 mm Hg
  2. To achieve central venous oxygen saturation (ScvO2) of > 70%
  3. To achieve MAP > 65mmHg and a urine output of >0.5mls/kg/hr
  4. The 24 hour SSC Management Bundle includes:
  5. Low-dose steroids administered for septic shock in accordance with a standardized ICU policy
  6. Glucose control maintained below upper limit of normal (8.3 mmol/L) with an insulin sliding scale regime (usually short-acting insulin such as Human Actrapid)
  7. Lung Protective Ventilator Strategy utilising 5–8 mls/kg tidal volumes for mechanically ventilated patients to avoid volutrauma and barotrauma.


  1. Surviving sepsis campaign
  2. History of sepsis
  3. Ingaz Semmelweis – reduced puerperal sepsis
  4. Louis Pasteur – founder of microbiology
  5. Joseph Lister – father of antisepsis
  6. Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis; N Engl J Med 2008; 358:125–139January 10, 2008DOI: 10.1056/NEJMoa070716
  7. RBC transfusion guidelines
  8. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis; The Lancet Infectious Diseases, Volume 13, Issue 5, Pages 426 – 435, May 2013 doi:10.1016/S1473–3099(12)70323–7
  9. Understanding of the Efficiency and Effectiveness of the Health Care System – Dartmouthatlas.org
  10. The Quality of Health Care Delivered to Adults in the United States; N Engl J Med 2003; 348:2635–2645June 26, 2003DOI: 10.1056/NEJMsa022615
  11. Use of a Computer Decision Support System and Antimicrobial Therapy Appropriateness
    Infection Control and Hospital Epidemiology , Vol. 34, No. 6 (June 2013), pp. 558–565
    Article DOI: 10.1086/670627