Additional Therapies

Corticosteroids should be considered for adults with septic shock and an ongoing requirement for vasopressors. IV hydrocortisone at 200 mg/day given as 50mg IV q6h can be considered if there is ongoing Norepinephrine requirement of ≥0.25 mcg/kg/min.
The use of restrictive over liberal transfusion strategy is recommended . The usual transfusion Hgb trigger of 70 g/L applies but clinical context needs to also be taken into account (e.g. more liberal transfusion with patients with myocardial ischemia or acute hemorrhage)
Stress ulcer prophylaxis is recommended for patients who have risk factors for GI bleeding. These risk factors are: coagulopathy, shock, and chronic liver disease.
Unless there is a contraindication, pharmacologic venous thromboembolism (VTE) prophylaxis is recommended. Low molecular weight heparin is preferred over unfractionated heparin.
Glucose control: it is recommended to initiate insulin therapy at a glucose level of ≥ 180mg/dL (10 mmol/L).
Sodium bicarbonate is recommended if there is metabolic acidosis (pH ≤ 7.2) and acute kidney injury (AKIN score 2 or 3).
If patients can be fed enterally, it recommended to institute early (within 72hr) enteral nutrition.

Reference: Evans, Laura et al. “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.” Critical care medicine vol. 49,11 (2021): e1063-e1143. doi:10.1097/CCM.0000000000005337