Sepsis Management Guidelines
In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis.
Xigris is a recombinant version of human Activated Protein C. The guidelines for management of severe sepsis and septic shock recommend recombinant human Activated Protein C (rhAPC) specifically:1
Xigris (rhAPC) and the Sepsis Management Guidelines
Recombinant Human Activated Protein C (rhAPC)
rhAPC is recommended in patients at high risk of death (Acute Physiology And Chronic Health Evaluation II >25, sepsis-induced multiple organ failure, septic shock, or sepsis-induced acute respiratory distress syndrome [ARDS]) and with no absolute contraindication related to bleeding risk or relative contraindication that outweighs the potential benefit of rhAPC.1
Grade of Recommendation: B*
The severe sepsis bundles
The severe sepsis bundles are a distillation of the evidence-based recommendations found in the 2004 practice guidelines recommended by the Surviving Sepsis Campaign.
A "bundle" is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. The individual bundle elements are built on upon evidence-based practices. The science behind the elements of a bundle is so well-established that their implementation should be considered a generally accepted practice.
Xigris (drotrecogin alfa [activated]) in the Sepsis Management Bundle
Administer Drotrecogin Alfa (Activated) by a Standard Policy
Bundle Element 2: Administer recombinant human activated protein C (rhAPC) in accordance with a standardized ICU policy. If not administered, document why the patient did not qualify for rhAPC.2
The severe sepsis bundles have been designed to allow teams to follow the timing, sequence, and goals of the individual elements of care. The bundles are a mechanism that can be used to achieve the Surviving Sepsis Campaign's goal of a 25 percent reduction in mortality from severe sepsis over 5 years.
Hospitals should implement the entire severe sepsis bundle (resuscitation and management). Each part of the bundle articulates objectives to be accomplished within specific time frames.
1. The Severe Sepsis Resuscitation Bundle describes seven tasks that should begin immediately, but must be accomplished within the first 6 hours of presentation for patients with severe sepsis or septic shock. Some items may not be completed if the clinical conditions described in the bundle do not prevail in a particular case, but clinicians must assess for them. The goal is to perform all indicated tasks 100 percent of the time within the first 6 hours of identification of severe sepsis.
> Implement the Severe Sepsis Resuscitation Bundle
2. The Sepsis Management Bundle lists four management goals. Efforts to accomplish these tasks should also begin immediately, but these items may be completed within twenty-four hours of presentation for patients with severe sepsis or septic shock.
*Supported by one level I investigation.
References:
- Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32(3):858-873.
- Surviving Sepsis Campaign. Severe Sepsis Bundles: Implement the 24-hour Bundle. Available at: http://ssc.sccm.org/24hr_bundles. Accessed May 2007.
