CLINICAL PRACTICE GUIDELINES FOR SEPSIS AND SEPTIC SHOCK IN ADULTS IN THE PHILIPPINES 2020 2 Table of Contents Participating Professional Medical Societies.............................................................................................. 3 Clinical Practice Guidelines for Sepsis and Septic Shock Task Force 2020 .................................... 4 Abbreviations ...................................................................................................................................................... 13 Introduction ......................................................................................................................................................... 15 Objectives of the Clinical Practice Guideline ........................................................................................... 18 Scope and Target Population ......................................................................................................................... 18 Target Audience and Users ............................................................................................................................ 18 Methodology ........................................................................................................................................................ 18 Health Questions Covered by this Guideline ........................................................................................... 23 SEPSIS DEFINITION AND CRITERIA FOR DIAGNOSIS .................................................................... 26 DIAGNOSTIC TESTS ...................................................................................................................................... 37 FLUID THERAPY ............................................................................................................................................ 41 VASOACTIVE AGENTS ................................................................................................................................. 58 HEMODYNAMIC MONITORING ................................................................................................................ 62 ANTIMICROBIAL THERAPY ...................................................................................................................... 70 SOURCE CONTROL ........................................................................................................................................ 93 CORTICOSTEROIDS ...................................................................................................................................... 96 GLYCEMIC CONTROL ................................................................................................................................. 100 ACUTE RESPIRATORY FAILURE............................................................................................................ 102 ACUTE KIDNEY INJURY ............................................................................................................................ 117 BLOOD PURIFICATION.............................................................................................................................. 125 BLOOD TRANSFUSION .............................................................................................................................. 127 IMMUNOGLOBULINS ................................................................................................................................. 133 ANTICOAGULANT THERAPY .................................................................................................................. 134 VENOUS THROMBOPROPHYLAXIS ...................................................................................................... 135 STRESS ULCER PROPHYLAXIS ............................................................................................................... 138 FEEDING AND NUTRITION...................................................................................................................... 141 SEDATION AND ANALGESIA................................................................................................................... 156 Clinical Practice Guideline for Sepsis and Septic Shock in Adults in the Philippines 2020 3 Participating Professional Medical Societies Philippine Society for Microbiology and Infectious Diseases (PSMID) Philippine Academy of Family Physicians (PAFP) Philippine College of Emergency Medicine, Inc. (PCEM) Philippine College of Physicians (PCP) Philippine College of Surgeons (PCS) Philippine College of Chest Physicians (PCCP) Philippine Heart Association (PHA) Philippine Medical Association (PMA) Philippine Neurological Association (PNA) Philippine Nurses Association (PNA) Philippine Society of Critical Care Medicine (PSCCM) Philippine Society of Endocrinology, Diabetes & Metabolism (PSEDM) Philippine Society of Gastroenterology (PSG) Philippine Society of General Internal Medicine (PSGIM) Philippine Society of Hematology & Blood Transfusion (PSHBT) Philippine College of Hematology & Transfusion Medicine (PCHTM) Philippine Society of Nephrology (PSN) Philippine Society for Parenteral & Enteral Nutrition (PhilSPEN) Clinical Practice Guideline for Sepsis and Septic Shock in Adults in the Philippines 2020 4 Clinical Practice Guidelines for Sepsis and Septic Shock Task Force 2020 STEERING COMMITTEE Chairpersons: Mari Rose A. De los Reyes, MD, FPCP, FPSMID Internal Medicine (IM)– Infectious Diseases Research Institute of Tropical Medicine Asian Hospital and Medical Center Marissa M. Alejandria, MD, FPCP, FPSMID IM– Infectious Diseases University of the Philippines – Philippine General Hospital The Medical City Members: Jubert P. Benedicto, MD, FPCP, FPCCP IM – Pulmonary Medicine University of the Philippines – Philippine General Hospital Lung Center of the Philippines Pauline F. Convocar, MD, MCHM, FPCEM, DPCOM Emergency Medicine Southern Philippines Medical Center Corazon Locsin Montelibano Memorial Regional Hospital Manila Doctors Hospital Jose Emmanuel T. Palo, MD, FCCM, FPSCCM IM - Critical Care The Medical City TECHNICAL WORKING GROUP Chair: Joseph Adrian L. Buensalido, MD, FPCP, FPSMID IM– Infectious Diseases University of the Philippines – Philippine General Hospital Asian Hospital and Medical Center Makati Medical Center Manila Doctors Hospital Co-Chair: Anna Flor Gaboy Malundo, MD, FPCP IM– Infectious Diseases University of the Philippines – Philippine General Hospital Clinical Practice Guideline for Sepsis and Septic Shock in Adults in the Philippines 2020 5 Members: CARDIOLOGY Jaime Alfonso M. Aherrera, MD, FPCP, FPCC University of the Philippines – Philippine General Hospital Asian Hospital and Medical Center De La Salle University Medical Center Manila Doctors Hospital Jose Donato A. Magno, MD,FPCP, FPCC, FPSE, FASE University of the Philippines – Philippine General Hospital Angeles University Foundation Medical Center Marie Kirk Patrich A. Maramara, MD, FPCP University of the Philippines – Philippine General Hospital Felix Eduardo R. Punzalan, MD,FPCP, FPCC University of the Philippines – Philippine General Hospital Manila Doctors Hospital Medical Center Manila CLINICAL EPIDEMIOLOGY (Technical Writer) Maria Teresa F. Sanchez-Tolosa, MD, D Clin Epi, FPDS University of the Philippines – Department of Clinical Epidemiology St. Luke’s Medical Center University of the East Ramon Magsaysay Memorial Medical Center CRITICAL CARE MEDICINE Gerardo M. Briones, Jr, MD, FPCP, FPSCCM Asian Hospital and Medical Center The Medical City Aaron Mark R. Hernandez, MD, FPCP, FPSCCM Asian Hospital and Medical Center The Medical City Anthony F. Pantaleon, MD, FPCP Asian Hospital and Medical Center Clinical Practice Guideline for Sepsis and Septic Shock in Adults in the Philippines 2020 6 Joanne B. Robles, MD, FPCP, FPNA, FPSCCM Asian Hospital and Medical Center The Medical City EMERGENCY MEDICINE Faith Joan M. Gaerlan, MD, FPCEM University of the Philippines – Philippine General Hospital Southern Philippines Medical Center St. Luke’s Medical Center – Quezon City Christopher G. Manalo, MD, DPCEM University of the Philippines – Philippine General Hospital ENDOCRINOLOGY Paulette D. Nacpil-Dominguez, MD, FPCP, FPSEDM University of the Philippines – Philippine General Hospital Delos Santos Medical Center Cardinal Santos Medical Center Diliman Doctors Hospital, Inc. Hannah C. Urbanozo-Corpuz, MD, FPCP, FPSEDM Ilocos Training and Regional Medical Center Lorma Medical Center GASTROENTEROLOGY AND NUTRITION Joyce B. Bernardino, MD, FPCP, DPBCN De La Salle Medical and Health Sciences Institute Rona Marie A. Lawenko, MD, FPSG, FPSDE De La Salle Medical and Health Sciences Institute Asian Hospital and Medical Center Elvie Victonette B. Razon-Gonzalez, MD, FPCP, FPSG, FPSDE Medicus Medical Center West Visayas State University Medical Center Iloilo Mission Hospital Iloilo Doctors Hospital Clinical Practice Guideline for Sepsis and Septic Shock in Adults in the Philippines 2020 7 HEMATOLOGY Teresita E. Dumagay, MD, FPCP, FPSHBT, FPCHTM University of the Philippines – Philippine General Hospital National Kidney and Transplant Institute Manila Doctors Hospital Manila Medical Center Josephine Anne C. Lucero, MD, FPCP University of the Philippines – Philippine General Hospital Anne Kristine H. Quero, MD, FPCP University of the Philippines – Philippine General Hospital Maria Clariza M. Santos, MD, FPCP, FPSHBT, FPCHTM University of the Philippines – Philippine General Hospital Makati Medical Center Manila Doctors Hospital