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Resuscitation of the Patient in Septic Shock

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Abstract

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. The mainstays of management include early recognition, source control, antibiotic treatment and effective resuscitation. In 2001, early goal-directed therapy (EGDT), a protocol for sepsis resuscitation, demonstrated decreased mortality among emergency department patients randomized to 6 h of EGDT versus usual care. EGDT utilized intravenous fluids, vasopressors, inotropes, and blood transfusions to achieve specific central hemodynamic goals. While this practice was adopted in international guidelines, concerns remain about the validity of this approach. Subsequent multisite randomized controlled trials published in 2014 and 2015 have demonstrated no mortality benefit with the use of EGDT versus usual care. The Surviving Sepsis Campaign (SSC) currently provides best practice guidelines for resuscitation of patients with sepsis and septic shock. Crystalloid is the initial fluid of choice for sepsis; albumin may be safely used as an adjunct for large volume resuscitation in the absence of traumatic injury. SSC endorses quantitative resuscitation within the first 6 h of care to achieve specific central hemodynamic goals and normalization of lactate. Sepsis resuscitation remains an active area for research investigation, and evidence-based guidelines will continue to reflect advances in knowledge.

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Abbreviations

6S:

Scandinavian starch for severe sepsis/septic shock

ALBIOS:

Albumin Italian outcome sepsis study

ARISE:

Australasian resuscitation in sepsis evaluation

CHEST:

Crystalloid versus hydroxyethyl starch trial

CRISTAL:

Colloids versus crystalloids for the resuscitation of the critically ill

cu mm:

Cubic millimeter

CVP:

Central venous pressure

EGDT:

Early goal-directed therapy

HES:

Hydroxyethyl starch

ICU:

Intensive care unit

IL:

Interleukin

LPS:

Lipopolysaccharide

MAP:

Mean arterial pressure

mm Hg:

Millimeters mercury

PaCO2 :

Partial arterial pressure of carbon dioxide

PaO2/FIO2 :

Ratio of arterial oxygen partial pressure to fractional inspired oxygen

PAMPs:

Pathogen-associated molecular patterns

ProCESS:

Protocolized care for early septic shock

ProMISe:

Protocolized management in sepsis

QSOFA:

Quick Sequential [Sepsis-Related] Organ Failure Assessment Score

SAFE:

Saline versus albumin fluid evaluation

SBP:

Systolic blood pressure

ScvO2 :

Central venous oxygen saturation

SIRS:

Systemic inflammatory response syndrome

SOFA:

Sequential [Sepsis-Related] Organ Failure Assessment Score

SSC:

Surviving sepsis campaign

SvO2 :

Mixed venous oxygen saturation

TLR:

Toll-like receptor

US:

United States

VISEP:

Efficacy of volume substitution and insulin therapy in severe sepsis

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Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Tower 110, Baltimore, MD, 21287, USA

    Lisa M. Kodadek

  2. Department of Surgery, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Osler 603, Baltimore, MD, 21287, USA

    Pamela A. Lipsett

Authors
  1. Lisa M. Kodadek
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  2. Pamela A. Lipsett
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Corresponding author

Correspondence to Lisa M. Kodadek .

Editor information

Editors and Affiliations

  1. R Adams Cowley Shock Trauma Center Acute Care Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Jose J. Diaz

  2. Acute Care Surgery, John Hopkins Hospital Acute Care Surgery, Baltimore, Maryland, USA

    David T. Efron

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Kodadek, L.M., Lipsett, P.A. (2017). Resuscitation of the Patient in Septic Shock. In: Diaz, J., Efron, D. (eds) Complications in Acute Care Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-42376-0_3

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  • DOI: https://doi.org/10.1007/978-3-319-42376-0_3

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