ICU SAQs · Resuscitation & shock
Assessing the adequacy of resuscitation in septic shock
A CICM SAQ on resuscitation endpoints — the three tiers (macro, metabolic, peripheral perfusion), with Rivers/ProCESS (ScvO2), Jansen (lactate), ANDROMEDA-SHOCK (capillary refill) and Ait-Oufella (mottling).
On this page
Study tools
Target exams
CICMFFICMEDIC
Prompt
A patient with septic shock remains hypotensive after 2 litres of crystalloid. Outline the endpoints you would use to assess the adequacy of resuscitation, and the evidence supporting them.
Question
A patient with septic shock remains hypotensive after 2 litres of crystalloid. Outline the endpoints you would use to assess the adequacy of resuscitation, and the evidence supporting them.
[3]References11ShowHide
- [1]Rivers E, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine, 2001.PMID 11794169
- [2]Jansen TC, et al. Early lactate-guided therapy in intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 2010.PMID 20463176
- [3]Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA, 2019.PMID 30772908
- [4]Ait-Oufella H, et al. Mottling score predicts survival in septic shock. Intensive Care Medicine, 2011.PMID 21373821
- [5]Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock (ProCESS). New England Journal of Medicine, 2014.PMID 24635773
- [6]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [7]Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 2021.PMID 34599691
- [8]Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest, 2008.PMID 18628220
- [9]Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA, 2010.PMID 20179283
- [10]Textoris J, Fouché L, Wiramus S, et al. High central venous oxygen saturation in the latter stages of septic shock is associated with increased mortality. Critical Care, 2011.PMID 21791065
- [11]Chertoff J, Chisum M, Garcia B, et al. Lactate kinetics in sepsis and septic shock: a review of the literature and rationale for further research. Journal of Intensive Care, 2015.PMID 26445673