Sepsis initial resuscitation

Immediate initial resuscitation of a patient in severe sepsis or sepsis-induced tissue B hypoperfusion should be instituted to achieve central venous pressure 8-12 mm Hg mean arterial pressure >65 mm Hg urine output >0.5 mt/kj hour, central venous or mixed venous oxygen saturation >70%... 

Rapid fluid resuscitation is the best initial therapeutic intervention for treatment of hypotension in sepsis. The goal is to maximize cardiac output by increasing the left ventricular preload, which will ultimately restore tissue perfusion. 

Septic patients have enormous fluid requirements as a result of peripheral vasodilation and capillary leakage. Rapid fluid resuscitation is the best initial therapeutic intervention for the treatment of hypotension in sepsis. The goal of fluid therapy is to maximize cardiac output by increasing the left ventricular preload, which ultimately will restore tissue perfusion. Fluid administration should be titrated to clinical end points such as heart rate, urine output, blood pressure, and mental status. An increased serum lactate level, a byproduct of cellular anaerobic metabolism, should normalize as the tissue perfusion improves. 

Agents commonly considered for vasopressor or inotropic support include dopamine, dobutamine, norepinephrine, phenylephrine, and epinephrine (Table 117 ). Dopamine, an a- and -adrenergic agent with dopaminergic activity, appears to increase MAP effectively in patients who remain hypotensive with reduced cardiac function after aggressive fluid resuscitation. Thus it is often the initial choice in sepsis because of combined vasopressor and inotropic effects. While low-dose dopamine (1 to 5 mcg/kg per minute) is effective in maintaining renal perfnsion, higher doses (>5 mcg/kg per minute) exhibit a and f) activity and are used frequently to support blood pressure and to improve cardiac function such as an increase in cardiac index (Cl). 

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