| Vasopressor and inotropic support in septic shock: an evidence-based review. | |
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MedLine Citation:
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PMID: 15542956 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for vasopressor and inotropic support in septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and to improve outcome in severe sepsis. DESIGN: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. METHODS: The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591. CONCLUSION: An arterial catheter should be placed as soon as possible in patients with septic shock. Vasopressors are indicated to maintain mean arterial pressure of <65 mm Hg, both during and following adequate fluid resuscitation. Norepinephrine or dopamine are the vasopressors of choice in the treatment of septic shock. Norepinephrine may be combined with dobutamine when cardiac output is being measured. Epinephrine, phenylephrine, and vasopressin are not recommended as first-line agents in the treatment of septic shock. Vasopressin may be considered for salvage therapy. Low-dose dopamine is not recommended for the purpose of renal protection. Dobutamine is recommended as the agent of choice to increase cardiac output but should not be used for the purpose of increasing cardiac output above physiologic levels. |
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Authors:
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Richard J Beale; Steven M Hollenberg; Jean-Louis Vincent; Joseph E Parrillo |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Critical care medicine Volume: 32 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2004-11-15 Completed Date: 2005-01-04 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: S455-65 Citation Subset: AIM; IM |
Affiliation:
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Guy's and St. Thomas' NHS Foundation Trust, London, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cardiotonic Agents
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administration & dosage* Catheterization Consensus Development Conferences as Topic Dobutamine / administration & dosage Dopamine / administration & dosage Evidence-Based Medicine Humans Norepinephrine / administration & dosage Practice Guidelines as Topic Shock, Septic / therapy* Vasoconstrictor Agents / administration & dosage* |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents; 0/Vasoconstrictor Agents; 34368-04-2/Dobutamine; 51-41-2/Norepinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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