Most relevant for MIC-elevated organisms and severe infections
Source control principles
Source identification mandatory for optimal outcomes
CT imaging for occult intra-abdominal sources
Echocardiography when endocarditis suspected
Timing of source control
Necrotizing fasciitis: immediate; cholecystitis: within 24-72 hours
Delay beyond 12 hours for other sources associated with mortality increase
Monitoring targets
MAP >= 65 mmHg as minimum target
Higher targets (70-80 mmHg) for known chronic hypertension
SEPSISPAM trial: MAP 80-85 mmHg did not improve overall mortality but reduced RRT
Capillary refill time normalization <= 3 seconds
ANDROMEDA-SHOCK trial: cap refill-guided resuscitation non-inferior to lactate-guided
Peripheral perfusion markers complementary to lactate
Patient Discharge Instructions
copy discharge instructions
Septic shock recovery information
Serious infection required ICU-level care
Full recovery may take weeks to months
Fatigue, weakness, and cognitive difficulty are common after critical illness
Antibiotics instructions
Complete the full antibiotic course as prescribed
Do not stop antibiotics early even if feeling better
Take with food if stomach upset occurs
Warning signs requiring immediate return to ER
Fever above 38.5 C or shaking chills
New confusion or difficulty thinking clearly
Dizziness or feeling faint when standing
Decreased urination less than usual
Worsening redness, swelling, or drainage from wound or IV site
Difficulty breathing or rapid breathing
New or worsening pain at site of original infection
Feeling significantly worse than at hospital discharge
Post-sepsis recovery expectations
Fatigue and weakness are common and may persist weeks to months
Gradual return to activity as tolerated
Physical therapy referral may be needed for deconditioning
Cognitive changes including memory and concentration difficulty
Brain fog can persist for months; seek assessment if concerning
Psychological effects including anxiety, depression, and PTSD are common
Follow-up appointment within 1-2 weeks is essential
Antibiotic course completion review
Blood tests to check kidney function and infection markers if recommended
Prevention of recurrence
Complete vaccination schedule (influenza, pneumococcal, others as indicated)
Wound care and hygiene for any remaining wounds
Avoid contact with sick individuals while immune system recovers
Report any new symptoms of infection promptly
References
Guidelines and key sources
Surviving Sepsis Campaign guidelines
Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Critical Care Medicine. 2026
Current gold standard guideline with strong and conditional recommendations
Available at doi.org/10.1097/CCM.0000000000007075
Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign 2021 guidelines. Critical Care Medicine. 2021
Predecessor guideline with landmark vasopressor and antibiotic recommendations
Sepsis-3 definition references
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016
Current operational definition: SOFA-based criteria with vasopressor/lactate threshold
Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition for Septic Shock (Sepsis-3). JAMA. 2016
Companion paper defining septic shock subpopulation
Emergency medicine key references
Long B, Gottlieb M. Emergency Medicine Updates: Evaluation and Diagnosis of Sepsis and Septic Shock. Am J Emerg Med. 2025
Long B, Gottlieb M. Emergency Medicine Updates: Management of Sepsis and Septic Shock. Am J Emerg Med. 2025
Yealy DM, Mohr NM, Shapiro NI, et al. Early Care of Adults With Suspected Sepsis in The ED. Annals of Emergency Medicine. 2021
Landmark trials and systematic reviews
Resuscitation trials
Meyer NJ, Prescott HC. Sepsis and Septic Shock. NEJM. 2024
Comprehensive review of pathophysiology, diagnosis, and management
Delaney A, Borges-Sa M, Chew MS, et al. Current Standard of Care for Septic Shock. Intensive Care Medicine. 2025
Contemporary review of standard-of-care evidence
Vasopressor trials
VASST trial: vasopressin versus norepinephrine in septic shock
No overall mortality difference; possible benefit in less severe shock
ANDROMEDA-SHOCK trial: capillary refill vs lactate-guided resuscitation
Jung RG, Gupta A, Stotts C, et al. Prognostic Factors Associated With Mortality in Septic Shock. Lancet Respir Med. 2026
Systematic review identifying key mortality predictors including cirrhosis (OR 1.85)
Raith EP, Udy AA, Bailey M, et al. Prognostic Accuracy of SOFA, SIRS, and qSOFA for ICU Mortality. JAMA. 2017
SOFA AUROC 0.74 outperformed qSOFA 0.64 for in-hospital mortality
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.