Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

The 2021 SSC guideline is the most comprehensive evidence-based guideline for sepsis and septic shock management, updating the 2016 guideline.

Evidence-based guideline using GRADE methodology by SCCM/ESICM.

Key 2021 updates: (1) Sepsis-3 definitions (qSOFA for screening); (2) Hour-1 bundle: lactate, cultures, broad-spectrum antibiotics within 1 hour, 30 ml/kg crystalloid, vasopressors if needed; (3) Norepinephrine first-line vasopressor; (4) Vasopressin add-on at norepinephrine ≥0.25 mcg/kg/min; (5) Hydrocortisone for refractory septic shock; (6) Balanced crystalloids preferred; (7) Corticosteroids in severe CAP (CAPE COD).

Know the Sepsis-3 definition (organ dysfunction + suspected infection), qSOFA criteria, and the Hour-1 bundle. Norepinephrine = first-line vasopressor. Add vasopressin at high norepinephrine doses. Hydrocortisone 200 mg/day for refractory shock. Antibiotics within 1 hour of sepsis recognition.

Guideline — evidence quality varies. Hour-1 bundle is controversial (fluid overload risk).