[Resuscitation strategy for patients with sepsis and septic shock]

Abstract

Fluid and vasopressor resuscitation is, along with antimicrobial therapy and control of the focus of infection, a basic issue of the treatment of sepsis and septic shock. There is currently no accepted protocol that we can follow for the resuscitation of these patients and the Surviving Sepsis Campaign proposes controversial measures and without sufficient evidence support to establish firm recommendations. We propose a resuscitation strategy adapted to the situation of each patient: in the patient in whom community sepsis is suspected, we consider that the early administration of 30mL/kg of crystalloids is effective and safe; in the patient with nosocomial sepsis, we must carry out a more in-depth evaluation before initiating aggressive resuscitation. In patients who do not respond to initial resuscitation, it is necessary to increase monitoring level and, depending on the hemodynamic profile, administer more fluids, a second vasopressor or inotropes.

Keywords: Cardiac output; Cardiotonic agents; Extracorporeal membrane oxygenation; Fluid responsiveness; Fluid therapy; Fluidoterapia; Gasto cardíaco; Haemodynamic monitoring; Inotrópicos; Monitorización hemodinámica; Oxigenación por membrana extracorpórea; Respuesta a fluidos; Sepsis; Septic shock; Shock séptico; Vasoconstrictor agents; Vasopresores.