From the Guidelines
Septic shock is a life-threatening condition that requires immediate intervention with a bundle approach, including initial resuscitation with intravenous crystalloid fluids at 30 mL/kg within the first 3 hours, administration of broad-spectrum antibiotics within 1 hour of recognition, and use of vasopressors if hypotension persists despite fluid resuscitation, with norepinephrine as the first-line agent 1.
Key Characteristics of Septic Shock
- Hypotension (systolic blood pressure <90 mmHg) despite adequate fluid resuscitation
- Elevated lactate levels (>2 mmol/L)
- Signs of organ dysfunction
Management of Septic Shock
- Initial resuscitation with intravenous crystalloid fluids at 30 mL/kg within the first 3 hours
- Administration of broad-spectrum antibiotics within 1 hour of recognition, such as piperacillin-tazobactam, meropenem, or a combination of vancomycin and cefepime
- Use of vasopressors if hypotension persists despite fluid resuscitation, with norepinephrine as the first-line agent, followed by vasopressin if needed
- Source control through drainage or removal of infected material
- Consideration of hydrocortisone for patients with refractory shock
- Glycemic control, venous thromboembolism prophylaxis, and stress ulcer prevention as important supportive measures
Importance of Early Recognition and Treatment
- Each hour of delay in appropriate antibiotic therapy increases mortality by approximately 7-8%
- Early recognition and aggressive treatment are crucial for improving patient outcomes
- The first few hours are critical for patient survival, and prompt intervention is essential to reduce morbidity and mortality 1.
From the FDA Drug Label
The following reactions can occur: Body As A Whole: Ischemic injury due to potent vasoconstrictor action and tissue hypoxia. Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy If plasma volumes are not corrected, hypotension may recur when LEVOPHED is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury.
The signs and symptoms of septic shock are not directly addressed in the provided drug labels. However, the labels do mention hypotension, tissue hypoxia, and lactic acidosis, which are related to septic shock.
- Hypotension is a key characteristic of septic shock.
- Tissue hypoxia and lactic acidosis can occur due to decreased perfusion and oxygen delivery to tissues. The management of septic shock involves fluid and electrolyte replacement therapy to correct plasma volume depletion and maintain blood pressure 2, 2.
From the Research
Characteristics of Septic Shock
- Septic shock is the most severe form of sepsis, characterized by persistent hypotension despite fluid resuscitation and the presence of tissue hypoperfusion 3
- It is defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation 4
- A systolic blood pressure less than 90 mmHg (or a fall in systolic blood pressure of > 40 mmHg), or a mean arterial pressure less than 65 mmHg after a crystalloid fluid challenge of 30 mL per kg body weight in a patient with severe sepsis, is a suggested definition for septic shock 4
- Delays in the diagnosis and initiation of treatment of septic shock is associated with increasing risk for mortality 3
Signs and Symptoms of Septic Shock
- Persistent hypotension despite fluid resuscitation 3
- Tissue hypoperfusion 3
- Systolic blood pressure less than 90 mmHg (or a fall in systolic blood pressure of > 40 mmHg) 4
- Mean arterial pressure less than 65 mmHg after a crystalloid fluid challenge of 30 mL per kg body weight in a patient with severe sepsis 4
- Leukocytosis, fever, tachycardia, tachypnea, and organ hypoperfusion 5
- Adult respiratory distress syndrome may occur 5
Management of Septic Shock
- Early and effective fluid resuscitation and vasopressor administration play a crucial role in maintaining tissue perfusion in septic shock patients 3
- Aggressive approach to the management of cardiovascular dysfunction in septic shock is warranted 6
- Large volume fluid resuscitation is instituted, with 0.9% normal saline as the first choice of resuscitation fluid 6
- Invasive hemodynamic monitoring using a flotation pulmonary artery catheter as well as invasive arterial blood pressure monitoring is necessary in the hemodynamic management of septic shock 6
- Vasopressor agents, such as dopamine and norepinephrine, are used to treat hypotension 6, 4
- Broad-spectrum empiric antibiotics are initiated at presentation, and modified based on the site of infection, prevailing organisms and antibiotic resistance patterns, and other specific risk factors 6
- Aggressive surgical debridement is pursued when appropriate 6