Pressors

Highlights from Sepsis surviving Campaign 2016: 

1. Base on ProCESS, ProMISe and ARISE trials,  all 3 trials confirmed that there was no survival benefit of EGDT compared to usual resuscitation.  However, in all three studies patients had early antibiotics, >30ml/kg of IVF prior to randomization.  We need therefore to keep in mind that the practice has changed.
2. Source control: empiric broad-spectrum therapy Abx to cover all likely pathogens within 1hr
3. Initial resuscitation: 30ml/kg of IV crystalloid fluid in first 3 hours and REASSESS fluid status & hemodynamic status with goal of MAP > 65mmHg
4. Norepinephrine as 1st choice vasopressor,  Vasopressin or Epinephrine are 2nd-line
5. Check Lactate clearance as marker of tissue hypoperfusion