Septic Shock Treatment

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Questions and Answers

What is the primary goal of fluid resuscitation in septic shock?

To correct acute circulatory dysfunction and maintain organ perfusion (correct)

To increase cardiac output to 10 L/min

To reduce serum lactate levels to less than 2 mmol/L

To achieve a mean systemic pressure of 60 mmHg

In patients with septic shock, what is the recommended fluid product for initial resuscitation?

Hydroxyethyl starch

Dextran

Albumin

0.9% sterile saline solution (correct)

What is the target serum lactate clearance rate for optimization of intravascular volume status?

More than 20% of baseline lactate measure

More than 30% of baseline lactate measure (correct)

More than 10% of baseline lactate measure

More than 40% of baseline lactate measure

What is the recommended vasopressor to start with in septic shock?

Norepinephrine Signup and view all the answers

What is the primary concept in initial hemodynamic optimization in septic shock?

Balance between macrovascular and microvascular shunts Signup and view all the answers

What is the recommended amount of intravenous crystalloid solution required in septic shock?

2-6 L Signup and view all the answers

What is the role of fluid administration in septic shock?

To correct hypovolemia and hypoperfusion Signup and view all the answers

What is the consequence of chloride-liberal intravenous fluid administration in septic shock?

Higher all-cause mortality Signup and view all the answers

What is the recommended monitor to be used for optimization of intravascular volume status?

Plateau monitor Signup and view all the answers

What is the timeframe to achieve lactate clearance of more than 30% of baseline lactate measure?

3-6 hours Signup and view all the answers

What is the primary goal of hemodynamic support during the initial phase of septic shock treatment?

To achieve a mean arterial pressure of at least 65 mmHg Signup and view all the answers

What is the recommended fluid administration strategy during the initial 3 hours of septic shock treatment?

Administer 30 mL/kg of crystalloids in the first 3 hours Signup and view all the answers

What is the importance of cardiac ultrasound in septic shock treatment?

It is used to determine the effectiveness of fluid therapy Signup and view all the answers

What is the primary fluid of choice for the initial resuscitation phase of septic shock treatment?

Crystalloids Signup and view all the answers

What is the target central venous pressure during the initial phase of septic shock treatment?

8-12 mmHg Signup and view all the answers

What is the primary method of measuring mean arterial pressure in septic shock treatment?

Using an intra-arterial pressure monitor Signup and view all the answers

What is the primary importance of hemodynamic stabilization in septic shock treatment?

It is crucial for improving patient outcomes Signup and view all the answers

What is the primary approach to hemodynamic support at the bedside in septic shock treatment?

Setting up an arterial catheter for continuous mean blood pressure monitoring Signup and view all the answers

Study Notes

Initial Resuscitation and Stabilization

Hemodynamic support is crucial during the initial phase of treating septic shock patients.
Hemodynamic targets during this phase include: • Mean arterial pressure (MAP) of at least 65 mmHg • Central venous pressure (CVP) of 8-12 mmHg • MAP measurement using esophageal or intra-arterial pressure, not sphygmomanometer
Cardiac ultrasound and systemic physical examination are essential to determine the clinical effects of fluid therapy.
Resuscitation should be started using crystalloids, with 30 mL/kg given in the first 3 hours.
Crystalloids, such as 0.9% saline and lactated Ringer solution, are the fluid of choice for this phase.

Hemodynamic Support

Initial approach at the bedside involves setting up arterial catheterization for continuous and invasive mean blood pressure monitoring.
Venous access for a central venous catheter is mandatory for serial serum lactate measurements and optimizing intravascular volume status.
Resuscitation goals and strategies differ depending on the underlying clinical scenario.
The approach is to rapidly increase blood flow, then correct fluid and vasopressor therapy with a goal of lactate clearance > 30% of baseline or serum lactate ≤ 2mmol/L.

Fluid Resuscitation

Initial management of septic shock includes intravenous fluid therapy to correct acute circulatory dysfunction and initiation of empirical broad-spectrum antimicrobials.
Hemodynamic stabilization should focus on maintaining adequate organ perfusion, while addressing other dysfunctional organs.
The primary adaptation during initial hemodynamic optimization should be based on the balance between macrovascular and microvascular shunts.
This balance is achieved by rapidly increasing mean systemic pressure (MSP), optimizing cardiac output, and arterial resistance in parallel.
Fluid resuscitation is the cornerstone of initial management, and impaired microcirculatory perfusion may be secondary to hypovolemia.
A cohort study showed that fluid administration plays a critical role in determining whether patients respond positively to initial resuscitation.
Restrictive fluid strategy does not significantly reduce mortality compared to a more liberal regimen.
Chloride-liberal intravenous fluid administration is associated with higher all-cause mortality compared to a chloride-restrictive regimen.

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Description

Learn about the initial phase of treating septic shock patients, including hemodynamic support and targets during this phase.