Initial Management for Septic Shock Due to Cellulitis

Fluid Resuscitation

Administer at least 30 mL/kg of crystalloid solution within the first 3 hours of resuscitation, as recommended by the Society of Critical Care Medicine (strong recommendation, moderate quality evidence) 1
Use crystalloids as the fluid of choice for initial resuscitation (strong recommendation, moderate quality evidence) 1
Either balanced crystalloids or normal saline can be used, though balanced solutions may be preferred to avoid hyperchloremic metabolic acidosis 1
Continue fluid administration as long as there is hemodynamic improvement based on dynamic measures or static variables 1, 3

Initiate vasopressor therapy if the patient remains hypotensive despite adequate fluid resuscitation, targeting a mean arterial pressure of 65 mmHg 1, 3
Use norepinephrine as the first-choice vasopressor (grade 1B) 1, 3
Consider adding epinephrine when an additional agent is needed to maintain adequate blood pressure 1, 3

Identify and address any potential source of infection requiring source control as rapidly as possible, as recommended by the Society of Critical Care Medicine 1
If intravascular access devices are a possible source of infection, remove them promptly after establishing alternative vascular access 1

Continuously monitor vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation 1, 2
Assess for signs of adequate tissue perfusion, including improved mental status, urine output, and peripheral perfusion 1, 2
Monitor for signs of fluid overload, such as pulmonary crackles, increased jugular venous pressure, and worsening respiratory function 4