Sepsis Protocols and Guidelines
According to the article “Early goal-directed resuscitation of patients with septic shock: urrent evidence and future directions,” central goal in the treatment of septic shock is the maintenance of adequate tissue perfusion with hemodynamic support, which includes intravenous fluid resuscitation, administration of vasopressors, inotropes, and packed red blood cells (Gupta et al., 2015). Early administration of antibiotics is also recommended. However, the authors state that obtaining at least two blood cultures prior to initiation of antibiotics is required. The authors pointed out to the evidence showing that each hour delay in the administration of antibiotic that is appropriate for the pathogen is associated with a 7.6 % increase in mortality (Gupta et al., 2015). Early goal directed therapy is still a widely accepted strategy, but the latest research showed that this policy does not significantly decrease mortality in patients with septic shock compared with usual care (Gupta et al., 2015). As a part of this approach, during the first 6 hours of septic shock, the patient needs to get a central venous catheter with an oximetric port for continuous monitoring of central venous pressure (CVP) and central venous oxygen saturation (ScvO2). Resuscitation with intravenous fluids, vasopressors, and packed red blood cells is required and titrated to specific parameters (Gupta et al., 2015).
Another article suggests that the most important intervention is the early bed site assessment of hemodynamic parameters and cardiac biomarkers (Sasko, 2015). Aggressive hemodynamic treatment has been shown to increase the survival of patients in septic shock (Sasko, 2015). The authors emphasized that early recognition, control of the source as well as effective therapy with antibiotics and hemodynamic stabilization are the most important cornerstones of the sepsis therapy (Sasko, 2015).
References
Gupta, R., Hartigan, S., Kashiouris, M., Sessler, C., & Bearman, G. (2015). Early goal-directed resuscitation of patients with septic shock: Current evidence and future directions. Critical Care, 19(286), 1-10. DOI 10.1186/s13054-015-1011-9
Sasko, B., Butz, T., Prull, M., Lieberton, J., Christ, M., & Trappe, H. (2015). Earliest bedside assessment of hemodynamic parameters and cardiac biomarkers: Their role as predictors of adverse outcome in patients with septic shock. International Journal of Medical Sciences, 12(9), 680-688. doi:10.7150/ijms.11720
