The Surviving Sepsis campaign developed care bundles for the initial management of a patient presenting with sepsis.
Within 3 hours of presentation:
(1) Measure serum lactate concentration.
(2) Obtain blood cultures prior to starting the administration of antibiotics.
(3) Administer broad-sprectrum antibiotics.
(4) Administer 30 mL/kg crystalloid for initial fluid resuscitation if the patient is hypotensive or if the serum lactate concentration is >= 4 mmol/L (36 mg/dL).
volume of crystalloid to administer for initial fluid resuscitation =
= (30 mL) * (kilograms body weight, adjusted for extremes of body weight)
Within 6 hours of presentation:
(1) Administer vasopressors if the patient is hypotensive after initial fluid resuscitation (septic shock).
(2) Monitor central venous pressure and central venous oxygen saturation if hypotensive after initial fluid resuscitation OR if initial lactate concentration >= 4 mmol/L.
Goals for resuscitation if in septic shock or with elevated lactate concentration:
(1) Maintain mean arterial pressure (MAP) >= 65 mm Hg
(2) Maintain central venous pressure (CVP) >= 8 mm Hg
(3) Maintain central venous oxygen saturation >= 70%.
(4) Normalize the serum lactate concentration.
