Sepsis is defined as the presence (probable or documented) of infection together with systemic manifestations of infection.

Severe sepsis is defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion
Septic shock is defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation.
Sepsis-induced hypotension is SBP < 90 mm Hg or MAP < 70 mm Hg or SBP decrease > 40 mm Hg or less than two standard
deviations below normal for age in the absence of other causes of hypotension.
Sepsis-induced tissue hypoperfusion is defined as infection-induced hypotension, elevated lactate (> 4 mmol/l), or oliguria.


first 6 hrs of resuscitation target (1C)
a) CVP 812 mm Hg, in mechanically ventilated patients or those with known preexisting decreased ventricular
compliance, increased abdominal pressure, a higher target CVP of 12 to 15 mm Hg should be achieved to account
for the impediment in filling.
Elevated CVP may also be seen with preexisting clinically significant pulmonary artery hypertension, making use
of this variable untenable for judging intravascular volume status.
b) MAP 65 mm Hg
c) Urine output 0.5 mL/kg/hr
d) Superior vena cava oxygenation saturation (Scvo2) or mixed venous oxygen saturation (Svo2) 70% or 65%,
respectively.

for achieving a CVP of 8 mm Hg and an ScvO2 of 70% dobutamine infusion (to a maximum of 20 g/kg/min) or
transfusion of packed red blood cells to achieve a hematocrit of greater than or equal to 30% in attempts to achieve
the Scvo2 or Svo2 goal are options.

Screenign sepsis and performance improvement using tools
Evaluation for severe sepsis screening tool. http://www.survivingsepsis.
org/files/Tools/evaluationforseveresepsisscreeningtool.pdf


blood cultures before antimicrobial
therapy is initiated if such cultures do not cause significant
delay (> 45 minutes) in the start of antimicrobial(s)
administration (aerobic and anaerobic) with at least one drawn percutaneously
and one drawn through each vascular access device, unless
the device was recently (< 48 hours) inserted
patients with indwelling catheters (for more than 48 hrs), at least
one blood culture should be drawn through each lumen of each
vascular access device (if feasible, especially for vascular devices
with signs of inflammation, catheter dysfunction, or indicators
of thrombus formation).
Blood volume for cultures > 10 ml
CRP dan procalcitonin tidak dapat membedakan inflamasi akut pada sepsis dengan inflamasi yang lainnya