Septic shock is perhaps the defining illness of medical intensive care. As such it is an enormously broad and controversial topic. This chapter attempts to provide a unified and straight-forward approach. However, every physicians has a different approach to septic shock, so it's impossible to claim that this is the best approach.
There will doubtless be vigorous debate about this topic, so I encourage all to leave their questions and comments below. This chapter will be revised on an ongoing basis, so the current form might be most realistically viewed as an outline for future revisions (rather than a final word on the topic).
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The IBCC chapter is located here.
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Amazing work as always.
I would like to know your opinion regarding P(v-a)CO2 difference as a marker of hypoperfusion. Since it is not necessary PAC as there is a good correlation between mixed venous and central venous CO2 (doi: 10.1007/s00134-013-2888-x.), this data could be easily obtained but it is (almost) never mentioned as rescuscitation endpoint.. Moreover, it has a strong physiopathological rationale (PMID: 16682934, or doi: 10.5492/wjccm.v5.i1.47.).
Here some references for who wants to go into deep
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642911/pdf/jtd-11-S11-S1574.pdf
https://www.ncbi.nlm.nih.gov/pubmed/6795375
https://ccforum.biomedcentral.com/articles/10.1186/cc13160
https://insights.ovid.com/crossref?an=00003246-199006000-00001
https://www.ncbi.nlm.nih.gov/pubmed/14656752
Thank you very much,
Carlo
Hi Josh ,
What do u suggest about optimal antibiotic dosing and therapeutic drug monitoring in sepsis and septic shock ?? As it is one of controversies in patient with AKI . Under dosing is major problem in critically ill . So what’s ur take on antibiotic dosing ?
There was a presentation at the ASHP Midyear 2018 conference related to antimicrobial dosing in sepsis. Long story short the opinion of the presenter was that given the often transient nature of AKI in patients admitted with sepsis it may be more benefit to consider dosing as if they had normal renal function for the first 24-48 hours. If we are looking at the potential adverse outcomes of under treated infection in the setting of sepsis vs adverse events from antimicrobial toxicity I feel that treating the infection aggressively is the better option. I typically am not too hasty with… Read more »
Amazing chapter as always.
Would love to know what your POV is with respect to literature surrounding methylene blue in severe vasodilatory septic shock non-responsive to all other therapies.
Have you had any experience administering it?
Reading periop literature, it does not seem to be something that necessarily should be a “last ditch effort”. I saw you mentioned one RCT which suggests increased mortality, curious to know your opinion in light of all available lit you might have come across.
As always- thank you.