Anestéziológia a intenzívna medicína 2/2021

Update of international recommendations for sepsis and septic shock management (2021)

Recommendations for the treatment of sepsis and septic shock have been published at approximately four-year intervals since 2008, which always provoke huge discussions in the professional community. The authors present updated recommendations commenting on some changes for current practice in Slovakia. These recommendations contain a total of 93 points. In 19 points it is a strong recommendation, but at the same time with the high quality of evidence there are only three points. First, the use of starches for volume resuscitation is not recommended in adults with sepsis or septic shock. In the second, in adults with septic shock, it is recommended to use norepinephrine as a first-line drug before other vasopressors. And the third states that in adults with sepsis-induced ARDS, it is recommended to use a ventilation strategy with a low tidal volume (6 ml/kg) as opposed to a procedure with a large tidal volume (> 10 ml/ kg). There are 9 strong recommendations with medium quality of evidence, 4 with low quality and 3 with very low. Other recommendations are suggestions and are based on lower quality evidence.

Keywords: sepsis, septic shock, guidelines, evidence based medicine