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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

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