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Open Access 01-04-2012 | Special Article

Recommendations for sepsis management in resource-limited settings

Authors: Martin W. Dünser, Emir Festic, Arjen Dondorp, Niranjan Kissoon, Tsenddorj Ganbat, Arthur Kwizera, Rashan Haniffa, Tim Baker, Marcus J. Schultz, Global Intensive Care Working Group of the European Society of Intensive Care Medicine

Published in: Intensive Care Medicine | Issue 4/2012

Abstract

Purpose

To provide clinicians practicing in resource-limited settings with a framework to improve the diagnosis and treatment of pediatric and adult patients with sepsis.

Methods

The medical literature on sepsis management was reviewed. Specific attention was paid to identify clinical evidence on sepsis management from resource-limited settings.

Results

Recommendations are grouped into acute and post-acute interventions. Acute interventions include liberal fluid resuscitation to achieve adequate tissue perfusion, normal heart rate and arterial blood pressure, use of epinephrine or dopamine for inadequate tissue perfusion despite fluid resuscitation, frequent measurement of arterial blood pressure in hemodynamically unstable patients, administration of hydrocortisone or prednisolone to patients requiring catecholamines, oxygen administration to achieve an oxygen saturation >90%, semi-recumbent and/or lateral position, non-invasive ventilation for increased work of breathing or hypoxemia despite oxygen therapy, timely administration of adequate antimicrobials, thorough clinical investigation for infectious source identification, fluid/tissue sampling and microbiological work-up, removal, drainage or debridement of the infectious source. Post-acute interventions include regular re-assessment of antimicrobial therapy, administration of antimicrobials for an adequate but not prolonged duration, avoidance of hypoglycemia, pharmacological or mechanical deep vein thrombosis prophylaxis, resumption of oral food intake after resuscitation and regaining of consciousness, careful use of opioids and sedatives, early mobilization, and active weaning of invasive support. Specific considerations for malaria, puerperal sepsis and HIV/AIDS patients with sepsis are included.

Conclusion

Only scarce evidence exists for the management of pediatric and adult sepsis in resource-limited settings. The presented recommendations may help to improve sepsis management in middle- and low-income countries.

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Title: Recommendations for sepsis management in resource-limited settings
Authors: Martin W. Dünser
Emir Festic
Arjen Dondorp
Niranjan Kissoon
Tsenddorj Ganbat
Arthur Kwizera
Rashan Haniffa
Tim Baker
Marcus J. Schultz
Global Intensive Care Working Group of the European Society of Intensive Care Medicine
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2468-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Recommendations for sepsis management in resource-limited settings

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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