Surviving Sepsis Campaign

Thanks, Kirsten, and this is a very common clinical question we face every day in the ICU.

The 2026 Surviving Sepsis Campaign guidelines recommend vasopressin for patients with escalating doses of norepinephrine, but the optimal timing for initiating vasopressin is unknown.

This new cluster randomized cluster crossover pragmatic trial included 3,959 adults with septic shock at 13 hospitals in Idaho and Utah.

Hospitals alternated monthly between recommending vasopressin at a fixed dose of 0.03 units per minute when other vasopressors reached 0.1 micrograms per kilogram per minute of norepinephrine or waiting until a higher norepinephrine threshold of 0.4 mics per kig per minute.

Hospitals should use a systematic screening approach.

The Surviving Sepsis Campaign guidelines recommend against using qSOFA alone as a screening tool because it misses many patients.

Instead, combine tools such as early warning scores.

NEWS 2 is widely used with clinical judgment.

A raised lactate identifies hidden hypoperfusion even when the blood pressure looks acceptable.

What should happen in the first hour?

The Surviving Sepsis Campaign describes an Hour 1 bundle.

First, measure lactate and remeasure it if it's above two.