Sepsis and Septic Shock Evaluation and Management Quiz

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Questions and Answers

Which organization still supports the previous definitions of systemic inflammatory response syndrome, sepsis, and severe sepsis?

Center for Medicare and Medicaid Services (CMS) (correct)

Society of Critical Care Medicine (SCCM)

Surviving Sepsis Campaign

Infectious Diseases Society of America (IDSA)

Which guidelines are the management of sepsis and septic shock consistent with?

Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM) guidelines

Surviving Sepsis Campaign 2021 guidelines (correct)

Center for Medicare and Medicaid Services (CMS) guidelines

Infectious Diseases Society of America (IDSA) guidelines

Which of the following is NOT a potential indicator of the severity of sepsis?

Hypotension

Hypoxemia

Elevated procalcitonin (correct)

Elevated serum lactate

What is the recommended upper limit of normal for serum lactate to indicate the severity of sepsis?

2 mmol/L Signup and view all the answers

What is the sensitivity of post-antimicrobial blood cultures in identifying pathogens in patients with sepsis?

53 percent Signup and view all the answers

What is the mortality benefit associated with procalcitonin use in patients with sepsis?

15 percent Signup and view all the answers

Which of the following is NOT a priority in the management of patients with sepsis and septic shock?

Administering antibiotics Signup and view all the answers

What is the ideal target range for peripheral saturation in patients with sepsis who require oxygenation?

90-96 percent Signup and view all the answers

When is intubation and mechanical ventilation typically required in patients with sepsis?

To support increased work of breathing Signup and view all the answers

When should central venous access be established in patients with suspected sepsis?

As soon as possible Signup and view all the answers

Which of the following is NOT mentioned as a potential marker of tissue perfusion after the restoration of perfusion?

Lactate clearance Signup and view all the answers

Which of the following laboratory studies are often performed until values have reached normal or baseline?

Platelet count Signup and view all the answers

Which of the following investigations should be considered in patients with sepsis within the first 12 hours?

Cultures and diagnostic samples Signup and view all the answers

Which of the following is NOT mentioned as a potential serologic assay for suspected invasive Candida or Aspergillus infection?

Cultures Signup and view all the answers

Which of the following is NOT mentioned as a potential source control measure in sepsis?

Angioplasty Signup and view all the answers

What is the potential risk of complications associated with source control interventions in sepsis?

Fistula formation Signup and view all the answers

What should be taken into consideration when deciding on the type and timing of source control in sepsis?

All of the above Signup and view all the answers

What is the recommended timing for source control in sepsis according to guidelines?

Within 6 to 12 hours after diagnosis Signup and view all the answers

What is the potential impact of inadequate source control in sepsis?

Increased risk of complications Signup and view all the answers

Which of the following interventions is mentioned as a potential source control measure in sepsis?

All of the above Signup and view all the answers

Which of the following is a target used to measure the response in the protocol-based approach for treating sepsis?

Mean arterial pressure (MAP) ≥65 mmHg Signup and view all the answers

Which of the following statements is supported by the evidence regarding early goal-directed therapy (EGDT) for sepsis?

EGDT targets include central line placement and lactate clearance. Signup and view all the answers

Which of the following statements is NOT true regarding the use of permissive hypotension in septic shock?

Permissive hypotension is associated with increased hospital mortality in patients aged 75 years or older. Signup and view all the answers

Which of the following statements is supported by the evidence regarding the mortality benefit of resuscitation protocols for septic shock?

A meta-analysis of 13 trials reported a mortality benefit from early-goal directed therapy within the first six hours. Signup and view all the answers

Which of the following is considered a dynamic measure of fluid responsiveness?

Radial artery pulse pressure Signup and view all the answers

Which of the following is NOT a static CVC measurement used to determine adequate fluid management?

MAP Signup and view all the answers

Which of the following is true regarding lactate clearance?

Lactate clearance is defined by the equation [(initial lactate – lactate >2 hours later)/initial lactate] x 100. Signup and view all the answers

Which of the following meta-analyses reported a reduction in mortality when lactate clearance strategies were used compared with usual care or ScvO2 normalization?

One meta-analysis of five low quality trials Signup and view all the answers

Which of the following is a key characteristic of sepsis?

It can result in organ dysfunction. Signup and view all the answers

What is the recommended approach for managing sepsis in the hospital setting?

Using a performance improvement program. Signup and view all the answers

What is the impact of sepsis worldwide?

It kills between one in three and one in six of those it affects. Signup and view all the answers

What is the purpose of the recommendations in the guidelines?

To reflect best practice in sepsis management. Signup and view all the answers

Which of the following is NOT a recommendation for the initial resuscitation of patients with sepsis-induced hypoperfusion or septic shock?

Guide resuscitation to decrease serum lactate in patients with elevated lactate levels. Signup and view all the answers

Which of the following is a weak recommendation for the management of adults with sepsis or septic shock?

Use capillary refill time to guide resuscitation. Signup and view all the answers

Which of the following is a strong recommendation for the management of adults with septic shock on vasopressors?

Maintain a mean arterial pressure (MAP) of 65 mm Hg. Signup and view all the answers

Which of the following is a best practice statement for the management of adults with sepsis or septic shock?

Treat and resuscitate immediately. Signup and view all the answers

Which of the following is a strong recommendation for adults with sepsis or septic shock at low risk of fungal infection?

Empiric use of antifungal therapy Signup and view all the answers

Which of the following is a best practice statement for adults with sepsis or septic shock?

Daily assessment for de-escalation of antimicrobials Signup and view all the answers

Which of the following is a strong recommendation for fluid resuscitation in adults with sepsis or septic shock?

Using balanced crystalloids Signup and view all the answers

Which of the following is a strong recommendation for vasopressor use in adults with septic shock?

Norepinephrine as the first-line agent Signup and view all the answers

Which of the following is NOT a component of sepsis performance improvement programs?

Patient outcomes Signup and view all the answers

Which of the following is NOT a sepsis screening tool?

Quick Sequential Organ Failure Score (qSOFA) criteria Signup and view all the answers

Which of the following is NOT associated with higher diagnostic accuracy for sepsis screening?

Modified Early Warning Score (MEWS) Signup and view all the answers

Which of the following is NOT mentioned as a potential location for sepsis screening?

Outpatient clinics Signup and view all the answers

Which vasopressor is suggested to be added for adults with septic shock on norepinephrine with inadequate mean arterial pressure levels?

Vasopressin Signup and view all the answers

What is the recommendation for adults with septic shock and inadequate mean arterial pressure levels despite norepinephrine and vasopressin?

Add epinephrine Signup and view all the answers

What is the recommendation for adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood pressure?

Add dobutamine to norepinephrine or use epinephrine alone Signup and view all the answers

Which of the following is a recommended therapy for adults with sepsis-induced moderate-severe ARDS?

Intermittent NMBA boluses Signup and view all the answers

In which situation is the use of Veno-venous (VV) ECMO suggested for adults with sepsis-induced severe ARDS?

When conventional mechanical ventilation fails in experienced centers Signup and view all the answers

What therapy is suggested for adults with septic shock and an ongoing requirement for vasopressor therapy?

IV corticosteroids Signup and view all the answers

What is the dose of IV hydrocortisone suggested for septic shock patients if adequate fluid resuscitation and vasopressor therapy are unable to restore hemodynamic stability?

200 mg/day Signup and view all the answers

Which of the following statements regarding the administration of antimicrobials for adults with possible septic shock or sepsis is correct?

Antimicrobials should be administered within 1 hour of recognition for both septic shock and sepsis without shock. Signup and view all the answers

Which of the following statements regarding the assessment of the likelihood of infectious versus noninfectious causes of acute illness for adults with possible sepsis without shock is correct?

Rapid investigation should be conducted if concern for infection persists. Signup and view all the answers

Which of the following statements regarding the administration of antimicrobials for adults with a low likelihood of infection and without shock is correct?

Antimicrobials should be deferred while closely monitoring the patient. Signup and view all the answers

Which of the following statements regarding the use of procalcitonin plus clinical evaluation to decide when to start antimicrobials for adults with suspected sepsis or septic shock is correct?

Procalcitonin plus clinical evaluation should not be used to decide when to start antimicrobials. Signup and view all the answers

Study Notes

Sepsis Management

The Society of Critical Care Medicine (SCCM) still supports the previous definitions of systemic inflammatory response syndrome, sepsis, and severe sepsis.
The management of sepsis and septic shock is consistent with the Surviving Sepsis Campaign (SSC) guidelines.

Sepsis Severity

A lactate level > 4 mmol/L is a potential indicator of the severity of sepsis.
The recommended upper limit of normal for serum lactate to indicate the severity of sepsis is 2 mmol/L.

Blood Cultures

The sensitivity of post-antimicrobial blood cultures in identifying pathogens in patients with sepsis is 5-15%.
Procalcitonin use in patients with sepsis is associated with a mortality benefit of 10-15%.

Resuscitation

In patients with sepsis, the ideal target range for peripheral saturation is ≥ 90% when oxygenation is required.
Intubation and mechanical ventilation are typically required in patients with sepsis who have respiratory failure or shock.
Central venous access should be established in patients with suspected sepsis who require vasopressors or have difficulty with peripheral access.

Tissue Perfusion

After restoration of perfusion, potential markers of tissue perfusion include lactate clearance, capillary refill, and urine output.

Laboratory Studies

Laboratory studies, including blood cultures and lactate levels, are often performed until values have reached normal or baseline.

Investigations

Investigations, such as blood cultures and imaging studies, should be considered in patients with sepsis within the first 12 hours.

Invasive Fungal Infections

Serologic assays for suspected invasive Candida or Aspergillus infection include beta-D-glucan and galactomannan.

Source Control

Potential source control measures in sepsis include antimicrobial therapy, abscess drainage, and debridement of infected tissues.
The potential risk of complications associated with source control interventions in sepsis is 5-10%.
When deciding on the type and timing of source control in sepsis, the need for prompt intervention should be balanced against the potential risks.
The recommended timing for source control in sepsis is within the first 6-12 hours.

Protocol-Based Approach

The target used to measure the response in the protocol-based approach for treating sepsis is lactate clearance and ScvO2 normalization.

Early Goal-Directed Therapy (EGDT)

EGDT for sepsis is associated with a mortality benefit.

Permissive Hypotension

Permissive hypotension is a potential therapeutic approach in septic shock.

Fluid Management

Dynamic measures of fluid responsiveness include stroke volume variation and pulse pressure variation.
The passive leg raise test is a dynamic measure of fluid responsiveness.
The CVP is not a reliable indicator of fluid responsiveness.
Lactate clearance is a predictor of hospital mortality in sepsis.

Sepsis Worldwide

Sepsis is a major public health concern worldwide, with an estimated 30 million cases and 6 million deaths annually.

Sepsis Guidelines

The purpose of the recommendations in the guidelines is to provide evidence-based guidance for the management of adults with sepsis or septic shock.
The recommended approach for managing sepsis in the hospital setting is a protocol-based approach with a focus on early recognition, early antibiotics, and early resuscitation.

Vasopressor Use

Norepinephrine is the first-choice vasopressor in septic shock.
Vasopressin should be added to norepinephrine if the patient has inadequate mean arterial pressure levels.
In adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood pressure, the use of inotropes is recommended.

ARDS Management

In adults with sepsis-induced moderate-severe ARDS, the recommended therapy is lung-protective ventilation with low tidal volumes and high PEEP.
In adults with sepsis-induced severe ARDS, the use of Veno-venous (VV) ECMO is suggested.

Corticosteroids

In adults with septic shock and an ongoing requirement for vasopressor therapy, the use of IV hydrocortisone is suggested.

Antimicrobials

Antimicrobials should be administered to adults with possible septic shock or sepsis within 1 hour.
In adults with a low likelihood of infection and without shock, antimicrobials should not be administered.
Procalcitonin plus clinical evaluation can be used to decide when to start antimicrobials for adults with suspected sepsis or septic shock.

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"Quiz: Evaluating and Managing Suspected Sepsis and Septic Shock" - Test your knowledge on the evaluation and management of suspected sepsis and septic shock, including topics such as removing infected implantable devices, abscess drainage, nephrostomy, debridement, and more.