Hey all, this is just a short snippet, not a full blog post. As the 2012 Surviving Sepsis Guidelines were just released, I‘m just making a few comments and directing you to Scott Weingart’s great podcast on the guidelines.
Everyone who takes care of emergent/critical care sepsis patients needs to take 18 minutes of their life and go listen to Scott Weingart’s new Practical Evidence podcast on the 2012 Surviving Sepsis guidelines here.
The whole document is 60 some pages, but the big highlights for me are:
1)Lactate clearance now included as measure of tissue perfusion – But there is also some BAD with this one (see below).
2)Norepinephrine is 1st choice vasopressor for all patients.
3)Epinephrine as 2nd vasopressor, followed by vasopressin (new does 0.03 units/min)
4)Dopamine pretty much gone – Yay!
5)Protective lung ventilation strategies for sepsis induced ARDS
1)Still recommending use of CVP goal of 8-12 mmHg to guide fluid therapy. Haven’t we beaten this dead horse enough. See here
2)Still recommends SCvO2 to monitor tissue perfusion. This is fine if you have a CVL, but they do not make mention of lactate clearance being non-inferior to SCvO2. Also discussed in previous post on CVL (linked above).
3)Recommends delaying antibiotics up to 45 mins to give BCx. Uh, isn’t time to antibiotics our #1 goal?
4)No recommendation for U/S of IVC, but still recommend static markers (HR/BP) to guide fluid responsiveness.
Scott does a great job of going over all of this and more in his podcast. A summary of the guidelines is also found there.