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Early Goal Directed Therapy of Severe Sepsis and Septic Shock. Emanual Rivers, 2001. The ground breaking study showing a mortality advantage of a flow sheet algorithm for a 6-hr resuscitation bundle that uses target levels of mean arterial pressure (MAP), central venous pressure (CVP), urine output and central venous oxygen saturation (ScvO2). Implemented in the Emergency Department this study provided much of the rationale for the Surviving Sepsis Campaign guidelines. |
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Elevated serum lactate is an important marker of the adequacy of tissue perfusion and is associated with increased mortality. Lactate > 4 mMol is representative of organ dysfunction and when coupled with SIRS and suspected source of infection a patient is defined as having severe sepsis. A goal of resuscitation is to reduce lactate to <2 mMol or decrease lactate ‘clearance’ more than 10% per hour. The use of 10% lactate clearance may be as effective as using ScvO2 > 70% as target for the resuscitation bundle. |
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Sepsis, Severe Sepsis and Septic Shock: Current Evidence For Emergency Department Management. Booker, 2011. Comprehensive review of the evidence based for sepsis identification and treatment in the Emergency Department. |
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Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Dellinger, 2008. The complete and official evidence base and guidelines for the Society of Critical Care Medicine’s Surviving Sepsis Campaign. New guidelines are expected to be published summer 2012. |