The 2012 Surviving Sepsis Campaign: Management of Severe Sepsis and Septic Shock-An Update on the Guidelines for Initial Therapy

With the 2012 Surviving Sepsis Campaign Guidelines, clinicians have access to evidence based guidelines for the treatment of adults with severe sepsis. Some of the important changes include: new recommendations for screening of adults with sepsis for organ dysfunction (grade 1C); lactate normalization as a therapeutic target in early resuscitation (grade 2C); colloids no longer recommended for initial resuscitation (grade 1B); a minimum of 30 mL/kg for initial fluid resuscitation (grade 1C); norepinephrine as the initial vasopressor of choice (dopamine allowed only under specific circumstances) (grade 1B); removal of recombinant human activated protein C for the treatment of severe sepsis (ungraded); removal of permissive hypercapnea as a recommendation (ungraded); and a change of the target blood glucose level to <180 mg/dL (previously 150 mg/dL) (grade 1A). In this article, we review the evidence base for these and other guideline changes for the early treatment of severe sepsis in adults.