From the Guidelines
To correct septic shock, immediate treatment with intravenous fluids, antibiotics, and vasopressors is essential, with the goal of restoring circulatory volume, eliminating the infectious trigger, and supporting failing cardiovascular function. The initial management should include rapid administration of crystalloid fluids, typically 30 ml/kg within the first 3 hours, to restore blood pressure and tissue perfusion, as recommended by the Surviving Sepsis Campaign guidelines 1. Simultaneously, broad-spectrum antibiotics should be administered within the first hour, such as a combination of piperacillin-tazobactam, vancomycin, or meropenem, adjusting based on suspected infection source 1. If hypotension persists despite fluid resuscitation, vasopressors should be started, with norepinephrine as first-line, titrating to maintain mean arterial pressure ≥65 mmHg, as supported by the 2016 Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock 1.
Some key points to consider in the management of septic shock include:
- Early recognition and prompt administration of intravenous fluids and vasopressors are crucial for effective treatment 1.
- The choice of antibiotic should be based on the suspected source of infection and local antimicrobial resistance patterns, with empiric broad-spectrum therapy recommended until culture results are available 1.
- Vasopressin may be added as a second agent if needed, but its use should be guided by clinical response and hemodynamic parameters 1.
- Monitoring of lactate levels, urine output, and hemodynamic parameters is essential to guide therapy and assess response to treatment 1.
- Corticosteroids may be considered for refractory shock, but their use should be based on individual patient assessment and clinical judgment 1.
Overall, the management of septic shock requires a multifaceted approach that addresses the underlying pathophysiology of the condition, including restoration of circulatory volume, elimination of the infectious trigger, and support of failing cardiovascular function. By following the recommended guidelines and tailoring treatment to individual patient needs, clinicians can improve outcomes and reduce mortality in patients with septic shock.
From the Research
Correction of Septic Shock
To correct septic shock, several steps can be taken:
- Early goal-directed resuscitation of the septic patient during the first 6 hours after recognition 2
- Appropriate diagnostic studies to ascertain causative organisms before starting antibiotics 2
- Early administration of broad-spectrum antibiotic therapy 2, 3, 4, 5
- Reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate 2
- A usual 7-10 days of antibiotic therapy guided by clinical response 2
Antibiotic Therapy
The choice of antibiotic therapy is crucial in the management of septic shock:
- Meropenem and piperacillin-tazobactam are popular and efficient treatments for sepsis and septic shock 3, 4
- Cefepime is an alternative broad-spectrum antipseudomonal beta-lactam antibiotic that can be used in the management of septic shock 5
- The dose of piperacillin-tazobactam should not be reduced in early phase septic shock, as it is associated with worsened clinical outcomes 4
Supportive Care
Supportive care is also essential in the management of septic shock:
- Aggressive fluid challenge to restore mean circulating filling pressure 2
- Vasopressor preference for norepinephrine and dopamine 2
- Stress-dose steroid therapy for septic shock 2
- A low tidal volume and limitation of inspiratory plateau pressure strategy for acute lung injury and acute respiratory distress syndrome 2
- Maintenance of blood glucose <150 mg/dL after initial stabilization 2