Current management of septic shock includes early administration of intravenous fluids, antimicrobial agents, and vasopressor support. While norepinephrine is recommended as the first-line vasopressor for septic shock in the 2016 Surviving Sepsis Campaign guidelines, vasopressin is a second-line vasopressor option that may be added.
Adult patients experiencing sepsis with hypotension but who did not meet the definition of septic shock received a median of 800 mL of intravenous fluid prior to initiation of norepinephrine 0.05 mcg/kg/min as a non-titratable infusion. Patients in this early vasopressor group had much lower odds of failing to achieve their primary outcome of adequate mean arterial pressure and tissue perfusion when early norepinephrine was provided.
In this systematic review and meta-analysis of randomized, controlled trials comparing administration of corticosteroids with placebo or standard supportive care in sepsis, corticosteroids were associated with reduced 28-day mortality.
The Infectious Diseases Society of America withheld its support for the Surviving Sepsis guidelines. The general concerns included vagueness and inconsistency in definition of sepsis, “one size fits all” prescription of time to administer antibiotics, lack of clarity around drawing blood cultures through IV catheters, recommendation of combination antibiotics, lack of definition around when to use procalcitonin levels, when and how to use pharmacokinetic and pharmacodynamic data effectively, prolonged antibiotic “prophylaxis,” and duration of therapy.
The ability to rapidly recognize infection, as well as distinguish inflammatory arthropathy from infection, crystal arthropathy, and osteoarthritis, makes arthrocentesis a valuable and sometimes essential emergency medicine procedure.