Sepsis Management: From Early Recognition to Evidence-Based Resuscitation

Early Recognition: qSOFA, SOFA, and the Sepsis-3 Definition

The Sepsis-3 definition (2016) established sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, operationalized as an acute change in SOFA score of 2 or more points. The qSOFA score (altered mentation, systolic BP 100 mmHg or less, respiratory rate 22 or more) serves as a bedside screening tool but has limited sensitivity. Current evidence supports using qSOFA for initial screening with SOFA-based confirmation.

The Hour-1 Bundle: Antibiotic Timing and Fluid Resuscitation

The Surviving Sepsis Campaign Hour-1 Bundle includes: measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or above, and apply vasopressors for MAP below 65 mmHg. Each hour of delay in antibiotic administration is associated with a 4-8% increase in mortality.

Fluid Resuscitation Strategy: Liberal vs. Restrictive

The CLASSIC and CLOVERS trials compared restrictive versus liberal fluid strategies in septic shock. Both found no significant difference in 90-day mortality, but the restrictive approach was associated with less fluid overload and fewer ventilator days. Current consensus supports an initial 30 mL/kg bolus with dynamic reassessment using point-of-care ultrasound, passive leg raise, and pulse pressure variation.