Evaluating Adherence to the 2021 Surviving Sepsis Campaign Guidelines for Sepsis and Septic Shock Management in Intensive Care Units: A Prospective Observational Study

This study evaluated adherence to the 2021 Surviving Sepsis Campaign (SSC) guidelines for managing sepsis and septic shock in a tertiary intensive care unit (ICU), aiming to identify deviations from recommended practices and their clinical implications. A prospective observational study was conducted over six months in the ICU of an academic tertiary-care hospital. Patients aged 50–80 years with sepsis or septic shock were enrolled (n=138). Adherence to 17 SSC 2021 recommendations was assessed using structured case report forms and electronic medical records, and clinical parameters, therapeutic interventions, and outcomes were analysed to determine adherence rates and areas of nonadherence. Adherence was high for foundational resuscitative measures, including early administration of intravenous crystalloids (100%), maintenance of mean arterial pressure (MAP) ≥ 65 mm Hg (100%), and comprehensive medication reconciliation (100%). In contrast, adherence to the recommendation against using the Quick Sequential Organ Failure Assessment as a sole screening tool was 0%. Adherence was suboptimal for low-molecular-weight heparin as the preferred agent for venous thromboembolism prophylaxis (57.1%) and for lung-protective ventilation in acute respiratory distress syndrome (75%). ICU mortality was 16.7%, and the 30-day readmission rate was 23.9%. While adherence to core resuscitative components of the SSC guidelines was robust, important gaps persisted in diagnostic screening practices, thromboprophylaxis choice, and ventilatory strategies, highlighting actionable targets for quality improvement.