ICU SAQs · Resuscitation
Initial resuscitation of septic shock
A core Second-Part management question on the Surviving Sepsis Hour-1 bundle applied to a shocked patient, with the evidence behind abandoning protocolised EGDT and the choice of fluid and vasopressor targets.
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Prompt
A 58-year-old woman presents with septic shock from a urinary source. After a 30 mL/kg crystalloid bolus she remains hypotensive (MAP 52 mmHg) with a lactate of 4.5 mmol/L. Outline your initial resuscitation over the first hour and the principles that govern ongoing fluid and vasopressor therapy.
Question
A 58-year-old woman presents with septic shock from a urinary source. After a 30 mL/kg crystalloid bolus she remains hypotensive (MAP 52 mmHg) with a lactate of 4.5 mmol/L. Outline your initial resuscitation over the first hour and the principles that govern ongoing fluid and vasopressor therapy.
[2]References5ShowHide
- [1]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
- [2]Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine, 2001.PMID 11794169
- [3]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
- [4]Rowan KM, Angus DC, Bailey M, et al. Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis. New England Journal of Medicine, 2017.PMID 28320242
- [5]Asfar P, Meziani F, Hamel JF, et al. High versus Low Blood-Pressure Target in Patients with Septic Shock (SEPSISPAM). New England Journal of Medicine, 2014.PMID 24635770