Sepsis - Hot Off the Press | The EM & Acute Care Course

Sepsis - Hot Off the Press by William Mallon, MD

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Key Points and Recommendations

1. Sepsis therapy is evolving and mortality rates remain high overall.
2. Lots of therapies have been tried (in 2019 alone) and shown to be of no measurable benefit.
3. Vitamin C didn’t alter the primary outcome in one trial but showed promise with a significant mortality reduction; there will be more research coming on this.
4. Cap refill seems to be a better marker for guiding sepsis management than lactate, which may reflect on how poor lactate is, or that cap refill and clinical evaluation remains under appreciated.
5. Corticosteroids for sepsis seem to be beneficial: mortality, ICU- and ventilator-days, and hemodynamic instability all may be reduced by them, but the controversy rages on.
6. Balanced crystalloid solutions like lactated ringers were beneficial in septic patients in one massive but non-blinded trial comparing them to normal saline.
7. Early shock control with norepi is being explored, and one early trial suggests a possible mortality benefit.
8. IV fluid restrictive strategies in sepsis are of great to interest to researchers; more to come on this, with hypertonic saline as a potentially useful tool.
9. Long-term follow-up from the ARISE trial suggests no benefit with EGDT over the long term (results consistent with shorter term results).
10. The SEP-1 performance measure bundles from CMS are lacking a reliable evidence base, and may not be feasible to implement.

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