Sepsis & Septic Shock

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (Sepsis-3 definition, 2016). Septic shock is a subset with circulatory, cellular, and metabolic abnormalities: vasopressor requirement to maintain MAP ≥65 and serum lactate >2 mmol/L despite adequate fluid resuscitation.

• 1Sepsis-3 (2016): SOFA score increase ≥2 + suspected infection
• 2Septic shock: vasopressor + lactate >2 despite fluids
• 3Hour-1 bundle: blood cultures, antibiotics, lactate, IV fluids (30 ml/kg), vasopressors if needed
• 4Antibiotics within 1 hour — every hour of delay increases mortality
• 5Norepinephrine = first-line vasopressor
• 6Vasopressin 0.03 units/min can be added second (VASST trial)
• 7Hydrocortisone 200 mg/day for refractory shock (ADRENAL, APROCCHSS)
• 8Balanced crystalloids preferred over normal saline (SMART trial)

• qSOFA (RR ≥22, altered mentation, SBP ≤100) is a screening tool, not diagnostic
• Lactate clearance ≥10% at 2 hours is a reasonable resuscitation target
• Source control within 6–12 hours is critical
• Avoid hyperglycemia: target glucose 140–180 mg/dL (NICE-SUGAR trial)