Additional Therapies
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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.
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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)
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Stress ulcer prophylaxis is recommended for patients who have risk factors for GI bleeding. These risk factors are: coagulopathy, shock, and chronic liver disease.
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Unless there is a contraindication, pharmacologic venous thromboembolism (VTE) prophylaxis is recommended. Low molecular weight heparin is preferred over unfractionated heparin.
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Glucose control: it is recommended to initiate insulin therapy at a glucose level of ≥ 180mg/dL (10 mmol/L).
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Sodium bicarbonate is recommended if there is metabolic acidosis (pH ≤ 7.2) and acute kidney injury (AKIN score 2 or 3).
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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