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Thoughts From A Clinician

Thoughts from a Clinician: Current Thoughts and Trends on Sepsis Management, Part 1


Perhaps it’s only me, but it seems that the “new” critical care buzz word of the quarter is sepsis; and honestly, why wouldn’t it be?  Sepsis is killing more and more patients and, to date, we have not figured out the magic bullet to proper sepsis therapy and treatment.  Since 2002, the Surviving Sepsis Campaign, has been working to develop awareness, create guidelines and publications, collect data on their recommended practice changes and lastly, continue to invigorate their campaign on sepsis identification and proper treatment.

Recently, and with much anticipation, they released new treatment bundles, consistent with best practices in sepsis identification and management.  A pivotal recommendation from this campaign was to choose Norepinephrine (Levophed) as a first line vasopressor instead of Dopamine.  Another salient algorithm, as recommended, includes therapy that is early and goal directed.  This is accomplished by using fluid resuscitation, antibiotics, Norepinhephrine (Levophed) infusion, and, if needed, a push dose vasopressor.  The bundles are directing succinct sepsis management by field providers, emergency departments, and intensive care departments all over the world (1).  By adopting current sepsis management, critical care teams can abandon traditional practice, which is basically guided by provider discretion.  The current environment allows most critical care teams and intensivists to treat as they see fit for their patients and sepsis.  In essence, if we follow the Surviving Sepsis guidelines and they lead the critical care team to success, this will undoubtedly lead to successful patient therapy.      

If only critical care practice was that easy.  Sepsis is a complex and complicated disease process and because of such, warrants time and attention to developing sound management practices.  At SMACC-US in Chicago this past year, many of the world’s sepsis leaders formed a panel and at the direction and guidance of Dr. Scott Weingart led a controversial, yet healthy discussion on sepsis care.  If you have not heard this talk please take the time to watch and listen at (2).  The conclusion from the panel discussion was that sepsis is a fickle pathology, meaning there are many opinions and ways to successfully treat the septic patient.  One consistent expert opinion that emerged from the talk was that septic patient’s require judicious and conservative volume resuscitation, meaning we do not want to give a sepsis patient more fluid than they may require (3).  Many critical care providers are already privy to this and through strict documentation of intake and output, do this very well.  As more information and research becomes available, its is recommended to stay current with such, to provide the best possible, goal directed therapy for the septic patient.

In a recent podcast, Dr. Weingart spoke with Dr. Jean-Francois Lanctot , a physician from Canada, about an emerging trend in sepsis management called Echo Guided Life Support or EGLS.  Using ultrasound therapy, Dr. Lanctot was able to effectively treat and customize sepsis therapy to his patients.  The merit of this diagnostic tool has proven to be effective, giving real time data in order to determine patient response to a specific therapy, such as fluid resuscitation.  Via ultrasound, we can measure the inferior and superior vena cavals versus traditional monitoring of the central venous pressure.  This was further supported by the Seven Mares trial, which was published by Dr. Paul Marik in July 2006 (4).  This study, figuratively, put a nail in the coffin of central venous pressure (CVP) and its use in determining intravascular volume status.  Additionally, this trial showed that there are many factors that can alter CVP and provoke treatment to be unreasonably modified to fit within a specified parameter.  EGLS and ultrasound guided therapy has become a trending FOAMed topic, with high hopes that it will continue to migrate into the world of critical care and emergency medical services.  For more information on pre-hospital and critical care ultrasound, please visit our friends at EMS Pocus (5)

Another question that is frequently posed is about temperature regulation and management.  Questions such as “Do we treat the fever or not” or “How important is temperature control in the septic patient” have generated research projects that are sure to change our thinking or behavior.  For more on fever management, in the presence of sepsis, and further analysis on the recommended sepsis bundles including the HEAT trial conclusions, please read Part 2 of this article.








Klint is a United States trained Critical Care Paramedic, who hold specialty certifications in neonatal and pediatric transport as well as being Flight Paramedic certified (FP-C).  He is currently pursuing a Baccalaureate degree in EMS Management through Western Carolina University.  Klint works full time as Flight Paramedic in the Midwest, USA.  He is also an EMS / Critical Care instructor with DistanceCME.  In addition, Klint is FlightBridgeED’s newest blog author and is heavily involved in Free Open Access Medication Education and EMS Education.  Klint can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. or on Twitter at @NoDesat



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