ICU · Resuscitation

Septic shock: Surviving Sepsis Campaign 2021

Also known as Surviving Sepsis Campaign (SSC) · Sepsis-3 definition · Hour-1 bundle · qSOFA · SOFA score · Lactate clearance · Noradrenaline first-line · Vasopressin in septic shock · Hydrocortisone refractory shock · Source control sepsis

The Surviving Sepsis Campaign 2021 guidelines (Evans et al.) provide the evidence-based standard of care for sepsis and septic shock and are the single most examined document in critical-care fellowship exams. Sepsis-3 (Singer 2016) defines sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection (SOFA change =2 from baseline); septic shock is a subset with both vasopressor-dependent hypotension (MAP =65) AND lactate 2 mmol/L despite fluids — hospital mortality 40%. The SSC 2021 HOUR-1 BUNDLE (replaced the 3-hour and 6-hour bundles): within ONE hour of recognition - (1) measure lactate, (2) obtain blood cultures BEFORE antibiotics, (3) administer broad-spectrum antibiotics, (4) at least 30 mL/kg crystalloid within the first 3 h for sepsis-induced hypoperfusion or septic shock, (5) vasopressors to hold MAP =65. Noradrenaline FIRST-LINE; add vasopressin 0.03 U/min (fixed) when noradrenaline reaches the 0.25-0.5 mcg/kg/min range; hydrocortisone 200 mg/day for ongoing vasopressor requirement (ADRENAL — faster shock resolution; APROCCHSS — 90-day mortality benefit). Balanced crystalloids PREFERRED over saline (SMART). Restrictive fluid strategy after initial resuscitation is safe (CLASSIC, CLOVERS). MAP target 65 mmHg — no benefit of higher (SEPSISPAM, except less RRT at 80-85 in chronic hypertensives). Lactate clearance =20% per 2 h guides resuscitation (ANDROMEDA-SHOCK). Source control within 6-12 h is advantageous.

Checked against its sources on 2 Sept 2026