Sepsis is defined as the presence (probable or documented) of infection together with systemic manifestations of infection.

Severe sepsis is defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusionSeptic shock is defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation. Sepsis-induced hypotension is SBP < 90 mm Hg or MAP < 70 mm Hg or SBP decrease > 40 mm Hg or less than two standard deviations below normal for age in the absence of other causes of hypotension.Sepsis-induced tissue hypoperfusion is defined as infection-induced hypotension, elevated lactate (> 4 mmol/l), or oliguria.

first 6 hrs of resuscitation target (1C)a) CVP 8–12 mm Hg, in mechanically ventilated patients or those with known preexisting decreased ventricular compliance, increased abdominal pressure, a higher target CVP of 12 to 15 mm Hg should be achieved to account for the impediment in filling.Elevated CVP may also be seen with preexisting clinically significant pulmonary artery hypertension, making useof this variable untenable for judging intravascular volume status. b) MAP ≥ 65 mm Hgc) Urine output ≥0.5 mL/kg/hrd) Superior vena cava oxygenation saturation (Scvo2) or mixed venous oxygen saturation (Svo2) 70% or 65%, respectively.

for achieving a CVP of 8 mm Hg and an ScvO2 of 70% dobutamine infusion (to a maximum of 20 μg/kg/min) or transfusion of packed red blood cells to achieve a hematocrit of greater than or equal to 30% in attempts to achieve the Scvo2 or Svo2 goal are options.

Screenign sepsis and performance improvement using toolsEvaluation for severe sepsis screening tool. http://www.survivingsepsis.org/files/Tools/evaluationforseveresepsisscreeningtool.pdf

blood cultures before antimicrobialtherapy is initiated if such cultures do not cause significantdelay (> 45 minutes) in the start of antimicrobial(s)administration (aerobic and anaerobic) with at least one drawn percutaneouslyand one drawn through each vascular access device, unlessthe device was recently (< 48 hours) insertedpatients with indwelling catheters (for more than 48 hrs), at leastone blood culture should be drawn through each lumen of eachvascular access device (if feasible, especially for vascular devices with signs of inflammation, catheter dysfunction, or indicatorsof thrombus formation).Blood volume for cultures > 10 mlCRP dan procalcitonin tidak dapat membedakan inflamasi akut pada sepsis dengan inflamasi yang lainnya