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Below is a list of pharmacy-related pearls from the 2016 Surviving Sepsis Guidelines:
- Fluid resuscitation: 30 mg/kg IV crystalloids within 3 hours (strong recommendation, low quality evidence)
- Vasopressors:
- MAP target 65 mm Hg (strong recommendation, low quality evidence)
- Norepinephrine 1st line (strong recommendation, moderate quality evidence). Epinephrine (weak recommendation, low quality evidence) or up to 0.03 Units/min vasopressin (weak recommendation, moderate quality evidence) may be added to NE.
- Antibiotics:
- Obtain blood cultures prior to administration, but do not delay antibiotics (best practice)
- Initiate empiric broad-spectrum antibiotics within 1 hour (strong recommendation, moderate quality evidence)
- Consider double gram-negative coverage in patients with septic shock at high risk of multidrug-resistant pathogen
- Risk factors for invasive Candida infection: immunocompromised state, TPN, necrotizing pancreatitis, recent major abdominal surgery, recent fungal infection
- Optimize pharmacokinetic/pharmacodynamic properties- e.g., IV loading dose of vancomycin of 25-30 mg/kg is favored (best practice)
- Corticosteroids: IV hydrocortisone 200 mg per day if hemodynamic stability is not achieved through crystalloids and vasopressors (weak recommendation, low quality evidence)
References
Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017; 3. [PMID 28098591]
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