Management of Septic Shock

Initial Assessment and Resuscitation

The Society of Critical Care Medicine recommends administering at least 30 mL/kg of IV crystalloid fluid within the first 3 hours for patients with septic shock, with a goal of achieving a mean arterial pressure (MAP) of 65 mmHg 1
Administer broad-spectrum antimicrobials as soon as possible and within one hour of recognition of septic shock, with the goal of covering all likely pathogens based on the clinical syndrome, patient history, and local epidemiology 2
Use a fluid challenge technique where fluid administration is continued as long as hemodynamic parameters continue to improve, with the goal of normalizing lactate levels in patients with elevated lactate levels as a marker of tissue hypoperfusion 1

The European Society of Intensive Care Medicine recommends using norepinephrine as the first-choice vasopressor for patients with persistent hypotension despite adequate fluid resuscitation, with a goal of achieving a MAP of 65 mmHg 1

The Society of Critical Care Medicine recommends applying oxygen to achieve an oxygen saturation >90%, and considering non-invasive ventilation in patients with dyspnea and/or persistent hypoxemia despite oxygen therapy 2
For patients with sepsis-induced ARDS, consider using higher PEEP over lower PEEP in moderate to severe ARDS, prone positioning for severe ARDS with PaO2/FiO2 ratio <150, and neuromuscular blocking agents for ≤48 hours in severe ARDS with PaO2/FiO2 ratio <150 mm Hg 5

The Society of Critical Care Medicine recommends implementing a protocolized approach to blood glucose management, targeting an upper blood glucose level ≤180 mg/dL, and minimizing continuous or intermittent sedation in mechanically ventilated sepsis patients, targeting specific sedation endpoints 6
Consider continuous renal replacement therapies to facilitate management of fluid balance in hemodynamically unstable septic patients 6

Avoid hydroxyethyl starches for fluid resuscitation due to increased risk of acute kidney injury and mortality, as recommended by the European Society of Intensive Care Medicine 1
Avoid fluid overresuscitation, which can delay organ recovery, prolong ICU stay, and increase mortality, as recommended by the Society of Critical Care Medicine 3