Am Fam Physician. 2022;106(5):589-590
Author disclosure: No relevant financial relationships.
Key Points for Practice
• Avoid the quick Sequential Organ Failure Assessment when diagnosing sepsis because of its inability to accurately rule out patients who will have poor outcomes from sepsis (i.e., low sensitivity). Systemic inflammatory response syndrome criteria, the National Early Warning Score, and the Modified Early Warning Score are more accurate.
• After initial resuscitation with 30 mL per kg of crystalloid fluids, further fluid resuscitation should be based on intravascular volume status and organ perfusion from dynamic measures.
• Empiric antibiotics should be started within one hour in septic shock and within three hours without shock. Empiric coverage for MRSA, gram-negative resistance, or fungal infection is recommended if these pathogens are considered likely.
• High-flow nasal oxygen should be considered to reduce the need for intubation in sepsis-induced hypoxic respiratory failure.
From the AFP Editors
Sepsis represents life-threatening organ dysfunction caused by a dysregulated response to infection that kills up to one in three affected people. Early identification and appropriate management can improve these outcomes. The Society of Critical Care Medicine has updated the guidelines of the Surviving Sepsis Campaign.
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