Shock Syndromes I

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

Shocka

Initial Resuscitation

Sepsis and septic shock are medical emergencies, and treatment and resuscitation are recommended to begin

immediately (BPS)

suggested to be given within the first 3 hr of resuscitation (weak recommendation, low quality of evidence)

Dynamic measures to guide fluid resuscitation are suggested over physical examination or static parameters

alone (weak recommendation, very low quality of evidence)

Guiding resuscitation to decrease serum lactate in patients with elevated lactate level is suggested (weak

recommendation, low quality of evidence)

Capillary refill time to guide resuscitation as an adjunct to other measures of perfusion is suggested (weak

recommendation, low quality of evidence)

An initial target MAP of 65 mm Hg is recommended in patients with septic shock requiring vasopressors

(strong recommendation, moderate quality of evidence)

Antimicrobial Therapy

In patients with possible septic shock or a high likelihood of sepsis, administering antimicrobials immediately,

ideally within 1 hr of recognition, is recommended (strong recommendation, low quality of evidence for septic

shock; very low quality of evidence for sepsis without shock)

causes of acute illness is recommended (BPS)

A time-limited course of rapid investigation and, if concern for infection persists, the administration of

antimicrobials within 3 hr from the time when sepsis was first recognized is suggested for patients with

possible sepsis without shock (weak recommendation, very low quality of evidence)

In patients with a low likelihood of infection and without shock, deferring antimicrobials while continuing to

closely monitor the patient is suggested (weak recommendation, very low quality of evidence)

Optimizing dosing strategies of antimicrobials based on accepted pharmacokinetic/pharmacodynamic

principles and specific drug properties is recommended (BPS)

Empiric antimicrobials with MRSA coverage are recommended in patients with sepsis or septic shock at high

risk of MRSA (BPS)

Two antimicrobials with gram-negative coverage are suggested for empiric treatment in patients with sepsis

or septic shock and at high risk for MDR organisms (weak recommendation, very low quality of evidence)

Double gram-negative coverage is not suggested once the causative pathogen and susceptibilities are known

(weak recommendation, very low quality of evidence)

Empiric antifungal therapy is suggested in patients with sepsis or septic shock at high risk of fungal infection

(weak recommendation, low quality of evidence)

recommendation, very low quality of evidence)

durations of antimicrobial therapy are suggested (weak recommendation, very low quality of evidence)

in patients with an initial diagnosis of sepsis or septic shock and adequate source control where optimal

duration of therapy is unclear (weak recommendation, low quality of evidence)