Shock Syndromes I

Box 1. Pharmacologic-Related Surviving Sepsis Campaign Recommendations for Patients with Sepsis and Septic

Shocka (continued)

Fluid Therapy

Crystalloids are recommended as first-line fluid for resuscitation (strong recommendation, moderate quality

of evidence)

quality of evidence)

Albumin is suggested in patients who received large volumes of crystalloids (weak recommendation, moderate

quality of evidence)

Starches are not recommended for resuscitation (strong recommendation, high quality of evidence)

Gelatin is not suggested for resuscitation (weak recommendation, moderate quality of evidence)

Vasoactive Medications

Norepinephrine is recommended as the first-line vasopressor (strong recommendation, high quality of evidence

over dopamine, moderate quality of evidence over vasopressin, low quality of evidence over epinephrine)

of escalating the dose of norepinephrine (weak recommendation, moderate quality of evidence)

Epinephrine is suggested in patients with septic shock and inadequate MAP levels despite norepinephrine and

vasopressin (weak recommendation, low quality of evidence)

For patients with septic shock and cardiac dysfunction with persistent hypoperfusion despite adequate volume

status and arterial blood pressure, either adding dobutamine to norepinephrine or using epinephrine alone is

suggested (weak recommendation, low quality of evidence)

Adding dobutamine to norepinephrine or using epinephrine alone is suggested in patients with septic shock

and cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood

pressure (weak recommendation, low quality of evidence)

Starting vasopressors peripherally to restore MAP rather than delaying initiation until a central venous access

is secured is suggested (weak recommendation, very low quality of evidence)

Corticosteroids

Corticosteroids are suggested for patients with septic shock and an ongoing requirement for vasopressor

therapy (weak recommendation, moderate quality of evidence)

aStrength and evidence level of recommendations listed in parentheses are according to the Grading of Recommendations Assessment, Development and Evaluation

(GRADE) system. The system classifies strength of recommendations as strong or weak and quality of evidence as high, moderate, low, or very low. BPSs represent

ungraded strong recommendations developed using strict criteria.

BPS = best practice statement; IV = intravenous(ly); MAP = mean arterial pressure; MDR = multidrug resistant; MRSA = methicillin-resistant Staphylococcus aureus.

Information from: Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit