Document Detail


Vasopressor and inotropic support in septic shock: an evidence-based review.
MedLine Citation:
PMID:  15542956     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Richard J Beale; Steven M Hollenberg; Jean-Louis Vincent; Joseph E Parrillo
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Critical care medicine     Volume:  32     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-15     Completed Date:  2005-01-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S455-65     Citation Subset:  AIM; IM    
Affiliation:
Guy's and St. Thomas' NHS Foundation Trust, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Cardiotonic Agents / 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:
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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