感染性休克
医学
去甲肾上腺素
败血症
重症监护医学
休克(循环)
加压素
拯救脓毒症运动
复苏
血管紧张素II
变向性
血管活性
麻醉
内科学
血压
严重败血症
多巴胺
作者
Mahmoud Ammar,Abdalla Ammar,Patrick M. Wieruszewski,Brittany D. Bissell,Micah T. Long,Lauren Albert,Ashish K. Khanna,Gretchen L. Sacha
标识
DOI:10.1186/s13613-022-01021-9
摘要
Abstract Septic shock remains a health care concern associated with significant morbidity and mortality. The Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock recommend early fluid resuscitation and antimicrobials. Beyond initial management, the guidelines do not provide clear recommendations on appropriate time to initiate vasoactive therapies and corticosteroids in patients who develop shock. This review summarizes the literature regarding time of initiation of these interventions. Clinical data regarding time of initiation of these therapies in relation to shock onset, sequence of treatments with regard to each other, and clinical markers evaluated to guide initiation are summarized. Early-high vasopressor initiation within first 6 h of shock onset is associated with lower mortality. Following norepinephrine initiation, the exact dose and timing of escalation to adjunctive vasopressor agents are not well elucidated in the literature. However, recent data indicate that timing may be an important factor in initiating vasopressors and adjunctive therapies, such as corticosteroids. Norepinephrine-equivalent dose and lactate concentration can aid in determining when to initiate vasopressin and angiotensin II in patients with septic shock. Future guidelines with clear recommendations on the time of initiation of septic shock therapies are warranted.
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