What's the mainstay treatment for septic shock?

From the Guidelines

The mainstay treatment for septic shock is early aggressive fluid resuscitation with crystalloids, typically 30 ml/kg within the first 3 hours, followed by vasopressor therapy when fluids alone cannot restore adequate blood pressure, as recommended by the Surviving Sepsis Campaign guidelines 1. The initial fluid resuscitation should be guided by frequent reassessment of hemodynamic status, and additional fluids should be administered as needed to maintain adequate blood pressure and perfusion 1. Norepinephrine is the first-line vasopressor, typically started at 0.05-0.1 mcg/kg/min and titrated to maintain a mean arterial pressure of at least 65 mmHg, as recommended by the guidelines 1. Broad-spectrum antibiotics should be administered within the first hour of recognition, with common regimens including combinations like vancomycin plus piperacillin-tazobactam or meropenem, adjusted based on suspected source and local resistance patterns 1. Source control through procedures like abscess drainage or removal of infected devices is essential when applicable, and adjunctive therapies may include corticosteroids (hydrocortisone 200 mg/day) for refractory shock, glycemic control targeting blood glucose below 180 mg/dL, and mechanical ventilation if respiratory failure develops 1. This approach addresses the pathophysiology of septic shock by restoring tissue perfusion, eliminating the infectious source, and supporting failing organ systems while the underlying infection resolves. Key considerations in the management of septic shock include:

• Early recognition and treatment of sepsis-induced hypoperfusion or septic shock 1
• Use of crystalloids as the initial fluid of choice for resuscitation 1
• Avoidance of hydroxyethyl starches for fluid resuscitation due to increased risk of acute kidney injury 1
• Consideration of albumin in patients who require substantial amounts of crystalloids 1
• Use of norepinephrine as the first-line vasopressor to maintain mean arterial pressure ≥ 65 mmHg 1
• Administration of broad-spectrum antibiotics within the first hour of recognition, with adjustment based on suspected source and local resistance patterns 1

From the FDA Drug Label

Clinical Considerations Disease-associated maternal and/or embryo/fetal risk Hypotension associated with septic shock is a medical emergency in pregnancy which can be fatal if left untreated Delaying treatment in pregnant women with hypotension associated with septic shock may increase the risk of maternal and fetal morbidity and mortality. The mainstay treatment for septic shock is not explicitly stated in the provided drug label, but it does mention that hypotension associated with septic shock is a medical emergency and that delaying treatment may increase the risk of maternal and fetal morbidity and mortality. However, the label discusses the use of epinephrine (IV) in the context of hypotension associated with septic shock, suggesting its potential role in treatment 2.

From the Research

Mainstay Treatment for Septic Shock

The mainstay treatment for septic shock involves several key components, including:

• Aggressive fluid resuscitation, with crystalloids being the preferred initial fluid choice 3
• Use of vasopressors, such as dopamine, norepinephrine, and phenylephrine, to support blood pressure 4, 5
• Inotropic agents, like dobutamine, to support cardiac output 4, 6
• Broad-spectrum empiric antibiotics, which should be initiated promptly and modified based on the site of infection, prevailing organisms, and other risk factors 4
• Supportive care, including hemodynamic monitoring and management of organ dysfunction 7, 6

Key Principles

Some key principles in the management of septic shock include:

• Early recognition and intervention, with a focus on rapid resuscitation and stabilization 7, 6
• Individualization of treatment, taking into account the patient's unique needs and response to therapy 7
• Use of dynamic variables to guide fluid resuscitation and vasopressor support 7
• Avoidance of certain types of fluids, such as hydroxyethyl starches, due to increased risk of adverse effects 3