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. Author manuscript; available in PMC: 2012 Dec 6.
Published in final edited form as: Med J Zambia. 2010;37(2):104–110.

Table 4.

Recommendations for management of severe sepsis and septic shock

Recommendation Considerations
Aggressive fluid resuscitation
     One litre in first 30 minutes
     Repeat every 30–60 minutes
  • -

    Most patients require 3–5L in 1st 6 hours

  • -

    Monitor CVP (goal: 8–12 mm Hg) or JVP (0 to 3 cm above sternal notch)

  • -

    Monitor urine output (goal: >0.5mL/kg/hr)
Vasopressors (if available) if pt still hypotensive after fluid challenge
  • -

    Target MAP ≥65

  • -

    Start dopamine at 5 mcg/kg/min
Obtain appropriate cultures and gram stains:
     Blood cultures (if available), sputum gram stain & culture; sputum AFB stain; urine dipstick, microscopy, and culture; deep pus swabs
  • -

    Obtain prior to antibiotics if possible

  • -

    Mycobacterial blood culture in HIV+ pts (if available)
Broad-spectrum antimicrobials
  • -

    Tailor empiric treatment to cover potential pathogens based on regional patterns and HIV status/CD4 count
Corticosteroids if patient still hypotensive after fluids and vasopressors, or if suspect HIV− or TB-related adrenal insufficiency
  • -

    Ensure that all suspected pathogens are treated
Blood transfusion if Hb < 7
  • -

    Goal Hb 7–9
Mechanical ventilation (if available) for patients in respiratory failure
  • -

    Set tidal volume at 5–7 mL/kg ideal body weight
Heparin 5000 Int Units SQ TID for DVT prophylaxis
  • -

    In all severe sepsis pts, if resources allow, unless contraindicate
H2 blocker or proton pump inhibitor for GI prophylaxis
  • -

    In all severe sepsis pts, if resources allow

  • -

    Weigh risks (pneumonia) and benefits in mechanically ventilated patients