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Hemodynamic Management

  • Crystalloid are recommended as first-line fluid for resuscitation. Balanced crystalloids are favoured over normal saline

  • For patient who have received large volume of crystalloids, albumin is recommended

  • Use of starches and gelatin is not recommended

  • Norepinephrine is recommended as the first-line vasopressor

  • Vasopressin should be added as a second vasopressor if norepinephrine does not achieve BP goals. The exact threshold for adding vasopressin is unknown but vasopressin can be considered at a Norepinephrine dose of 0.25 mcg/kg/min

  • Epinephrine can be added as a third vasopressor if norepinephrine and vasopressin do not achieve blood pressure goals

  • Dobutamine can be added to Norepinephrine if there is cardiac dysfunction with persistent hypoperfusion despite adequate volume status and arterial blood pressure

  • Vasopressors can initially be given peripherally and initiation should not be delayed to first secure central venous access


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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