Sepsis hemodynamic update part two
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The document outlines guidelines for managing sepsis and septic shock, emphasizing the importance of early identification and treatment. Key recommendations include maintaining a mean arterial pressure of 65 mm Hg, using crystalloids as the first-line fluid for resuscitation, and prioritizing norepinephrine as the primary vasopressor. Additional suggestions address fluid management strategies, monitoring approaches, and the cautious use of alternative vasopressors when norepinephrine is unavailable.
Sepsis hemodynamic update part two
- 1. Sepsis hemodynamic update part two Dr. Mohammed Abdelaziz Salim ICU physician Meeqat General Hospital
- 2. Sepsis is a potentially life-threatening condition that occurs when the body response to an infection damage its own tissue. When the infection fighting processes turn on the body they cause organs to function poorly and abnormally. Sepsis may progress to septic shock. This is a dramatic drop in blood pressure that can lead to sever organ problems and death.
- 3. Mean arterial pressure 9- For adults with septic shock on vasopressors, we recommend an initial target mean arterial pressure (MAP) of 65 mm Hg over higher MAP targets. Strong recommendation
- 4. Fluid management 32- For adult with sepsis or septic shock we recommend using crystalloids as first line fluid for resuscitation. (strong recommendation) 33- For adults with sepsis or septic shock we suggest using balanced crystalloids instead of NS of resuscitation. (weak recommendation) 34- For adults with sepsis or septic shock we suggest using albumin in patient who receive large volume of crystalloids over using crystalloids alone. 35- For adults with sepsis or septic shock we recommend against using starches for resuscitation. (strong recommendation) 36- For adults with sepsis or septic shock we suggest against using gelatin for resuscitation. (weak recommendation)
- 5. Fluid balance There is insufficient evidence to make a recommendation on the use of restrictive versus liberal fluid strategies in the first 24 hrs. of resuscitation in patient with sepsis or septic shock who still have signs of hypoperfusion and volume depletion after initial resuscitation. Fluid resuscitation should be given only if patient present with signs of hypoperfusion
- 7. Vasoactive Agent Management 37-For adult with septic shock we recommend using norepinephrine as the first line agent over other vasopressors. ( strong recommendation) Dopamine. (High quality evidence) Vasopressin. (Moderate quality evidence) Epinephrine. (Low quality evidence) Selepressin. (Low quality evidence) Angiotensin II. (Very low quality evidence) Notes: In case of norepinephrine is not available, epinephrine or dopamine can be used as alternative, but we encourage efforts to improve availability of norepinephrine. Special attention should be given to patients at risk for arrhythmias
- 8. 38- For adults with septic shock on norepinephrine with inadequate MAP level we suggest adding vasopressin instead of escalating the dose of norepinephrine. ( weak recommendation) In ICU practice vasopressin usually started when the dose of norepinephrine is in the range of 0.25 – 0.5 ug/kg/min. 39- For adults with septic shock and inadequate MAP level despite norepinephrine and vasopressin we suggest adding epinephrine. (weak recommendation) 40- For adults with septic shock we suggest against using terlipressin. (weak recommendation)
- 9. 41- For adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume state and arterial blood pressure we suggest either adding dobutamine to norepinephrine or using epinephrine alone. (weak recommendation) 42- For adults with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood pressure we suggest against using levosimendan. (weak recommendation)
- 10. Monitoring and intravenous access 43- For adults with septic shock we suggest using invasive monitoring of arterial pressure over non invasive monitoring. (weak recommendation) 44- For adults with septic shock we suggest starting vasopressors peripherally to restore MAP rather than delaying initiation until a central access is secured. (weak recommendation) Notes : When using vasopressors peripherally they should be administered only for short period of time and in a vein in or proximal to the antecubital fossa ..