Septic shock fluid therapy

An important overall approach for treatment of sepsis is goal-directed therapy. Mortality can be reduced by early placement and use of a central venous catheter, increased fluid volume administration, dobutamine therapy if needed, and red blood cell transfusion, to achieve specific physiologic goals in the first 6 hours. Evidence-based treatment recommendations for sepsis and septic shock from the Surviving Sepsis campaign are presented in Table 45-3. 

Hemodjmamic and cardiac complications are the major limitations of high-dose aldesleukin and have been described in both adults (19,20) and children (21). Significant hypotension requiring meticulous maintenance therapy with intravenous fluids or low-dose vasopressors was observed in most patients (22). The clinical findings were very similar to the hemodynamic pattern seen in early septic shock. Aldesleukin-induced increases in plasma nitrate and nitrite concentrations correlated with the severity of hypotension (23). 

Early goal-directed therapy with aggressive fluid resuscitation in the emergency department within the first 6 hours of presentation improves survival in sepsis and septic shock. 

When deciding to treat a suspected episode of ICU-acquired pneumonia, several aspects should be taken into account. The importance of early initiation of an adequate antimicrobial therapy for the treatment of VAP has been emphasized in recent years in several studies. Alvarez-Lerma evaluated 430 patients with VAP and found a higher attributable mortality (24.7% vs. 16.3%, p = 0.039) and a higher incidence of septic shock and gastrointestinal bleeding among patients receiving inadequate initial treatment. Similar results were also reported by Luna and coworkers and Rello and cols. With mini-BAL fluid cultures, Kollef and Ward reported that inappropriate antibiotic therapy was associated with an OR for death of 3.28. 

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