From the Research
Management of post-sepsis vascular dysfunction and post-sepsis syndrome requires a comprehensive, multidisciplinary approach, prioritizing close follow-up, judicious fluid management, and careful use of vasopressors like norepinephrine, as recommended by recent studies 1, 2. The goal of this approach is to minimize morbidity, mortality, and improve quality of life for patients recovering from sepsis. Key components of this approach include:
- Close monitoring of cardiovascular parameters, including blood pressure and heart rate, to guide the use of vasopressors and other supportive therapies
- Judicious fluid management, targeting euvolemia while avoiding fluid overload, as emphasized in studies on sepsis management 3, 4
- Use of vasopressors like norepinephrine, starting at 0.05-0.1 mcg/kg/min, or vasopressin, 0.01-0.04 units/min, for short-term management of persistent hypotension, with careful weaning as vascular function improves
- Cardiovascular medications, such as beta-blockers (metoprolol 25-100 mg twice daily) or ACE inhibitors (lisinopril 2.5-40 mg daily), to manage hypertension that can develop during recovery
- Early initiation of physical rehabilitation, with gradual progression from passive to active exercises, to improve functional outcomes and reduce the risk of long-term disability
- Nutritional support, with adequate protein (1.2-2.0 g/kg/day) and caloric intake, to promote recovery and minimize the risk of malnutrition
- Cognitive rehabilitation, as needed, to address post-sepsis cognitive impairment, and psychological support through counseling or therapy to address common issues like anxiety, depression, and PTSD, as highlighted in studies on post-sepsis syndrome 2. This multifaceted approach targets the underlying pathophysiology of post-sepsis syndrome, including persistent inflammation, immunosuppression, and endothelial dysfunction, to improve outcomes and reduce the burden of sepsis on patients and healthcare systems 5, 1.