Recommendations
4. Sepsis and septic shock are medical emergencies, and we recommend that treatment and resuscitation begin immediately Best Practice Statement
5. For patients with sepsis induced hypoperfusion or septic shock we suggest that at least 30 mL/kg of intravenous (IV) crystalloid fluid should be given within the first 3 h of resuscitation Weak recommendation, low-quality evidence
6. For adults with sepsis or septic shock, we suggest using dynamic measures to guide fluid resuscitation, over physical examination or static parameters alone Weak recommendation, very low-quality evidence Remarks Dynamic parameters include response to a passive leg raise or a fluid bolus, using stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), or echocardiography, where available
7. For adults with sepsis or septic shock, we suggest guiding resuscitation to decrease serum lactate in patients with elevated lactate level, over not using serum lactate Weak recommendation, low-quality evidence Remarks During acute resuscitation, serum lactate level should be interpreted considering the clinical context and other causes of elevated lactate
8. For adults with septic shock, we suggest using capillary refill time to guide resuscitation as an adjunct to other measures of perfusion Weak recommendation, low-quality evidence