Week 17: Everything sepsis

The bulk of an ICU's workload, but also the most discussed topic with the most widely varying opinions. It's sepsis!

Things to consider

• What actually is sepsis? Why is there so much argument about this?

• What's the glycocalyx and why do we keep talking about it?

• Surviving Sepsis - "sepsis six" and the evidence

• Surviving surviving sepsis - de-escalation and de-resuscitation

• Does paracetamol treat sepsis? Does Tazocin treat every fever?

• Treatment options - when to use vasopressors? Steroids? IV Ig? Vitamin C?!

• Managing the pyrexia of unknown origin

Resources

• Clifford Deutschmann talks definitions (CRR)

• ESICM reviews all the sepsis-3 articles

• Collection of all the ESICM/Surviving Sepsis guidelines

• The pathophysiology of sepsis... maybe (LITFT)

• Management of sepsis and septic shock (IBCC)

• Review of the evidence behind steroids in sepsis (TBL)

• Timing and characteristics of antibiotics in sepsis (LITFL)

• Understanding lactate in sepsis (EMCrit)

• Sepsis for the anaesthetist (BJA)

• Sepsis in adults (BMJ)

• Metabolic acidoses (and lactate) - parts 1 and 2 (Anaesthesia)

Key studies and guidelines

• Defining sepsis: Sepsis-3, and the NICE guidelines (and of course they're different)
• EGDT: Rivers, ARISE, ProCESS, ProMISe... And yet EGDT still won't die
• Fluids: 6S, CHEST, Cochrane review (see also EGDT), CLASSIC, FEAST, ALBIOS
• BP targets: 65, SEPSISPAM
• Choise of vasopressors: REFRESH, CENSER, VASST, VANISH, Terli vs norad, methylene blue vs vaso, ATHOS-3, CATS (and a meta-analysis)
• Steroids: ADRENAL, APROCCHSS, HYPRESS, CORTICUS, hydrocortisone/fludrocortisone
• Vitamin C: The original "trial", CITRIS-ALI, VITAMINS, ATESS
• Antibiotics: Does timing matter, BLISS, STOP-IT
• Blood cultures: FABLED
• IV Ig: INSTINCT
• Blood: TRISS
• Things you shouldn't do: Levosimendan (LeoPARDS), APC (PROWESS-SHOCK)

Have we missed something?

Know a great resource or teaching aid that we've missed? Let us know and help make this page even better.