Table 7 Summary of the five interventions and recommendations of the panel on clinical application of each
Intervention | Patient population studied | Timing of intervention | Recommendations of the panel |
|---|---|---|---|
Low tidal volume | ALI/ARDS patients fulfilling blood gas criteria and with bilateral infiltrates | Evidence of ALI/ARDS. Earlier application warranted in patients with sepsis likely to develop ALI/ARDS | Tidal volume should be limited to ~6 ml/kg in patients with ALI/ARDS requiring mechanical ventilation |
Early goal-directed therapy | Emergency room patients with two out of the four SIRS criteria and systolic blood pressure ≤ 90 mmHg or lactate ≥ 4 mmol/l | Pre entry into the ICU | Severe sepsis and septic shock patients should receive early aggressive hemodynamic therapy, and fluids and inotropic agents where indicated |
Drotrecogin alfa (activated) | Severe sepsis patients as defined by three or more SIRS criteria plus at least one acute organ dysfunction | Within 48 hours of diagnosis of the most recent organ dysfunction | Patients with severe sepsis and high risk of death (e.g. APACHE II score ≥ 25, or two or more organ dysfunctions) |
Moderate-dose corticosteroids | Refractory septic shock | As soon as refractory septic shock develops | Administer to refractory septic shock patients, particularly those with relative adrenal insufficiency, after an ACTH test has been carried out |
Tight control of blood sugar | Mostly surgery patients with SIRS or sepsis | ICU admission | Tightly control blood sugar close to physiologic levels |