| Strategy | Recommendations |
---|---|---|
Blunt endogenous catecholamine release; avoid compensatory adrenergic stimulation | Optimize cardiac preload and vascular filling | Assess fluid status by leg-raise test |
Perform repetitive fluid challenges to a target (e.g. stroke volume) | ||
Use cardiac output monitoring and/or echocardiography | ||
Treat hypoxia and severe anaemia | Target oxygen saturation between 92–96 % | |
Transfuse red blood cells if haemoglobin falls below 70Â g/l | ||
Optimize sedation and analgesia | Avoid over-sedation; use sedation targets | |
Interrupt sedation daily, especially if long-lasting sedatives (e.g. midazolam) are used | ||
Use dexmedetomidine (see text for details) | ||
Reduce exogenous catecholamine administration | Avoid excessive beta-mimetic stimulation | Use cardiac output monitoring and/or echocardiography Avoid supra-normal physiological targets |
Only use inotropes if contractility is impaired | Use cardiac output monitoring and/or echocardiography | |
Consider alternative drugs | Consider alternative inotropes (e.g. levosimendan) and vasopressors (e.g. vasopressin) | |
Accept abnormal physiological values | Adjust therapeutic targets | |
Consider beta-blockers if tachycardia persists | Prefer short-acting drugs (e.g esmolol, see text) that can be stopped if adverse effects occur | |
Blunt inflammatory response (to reduce cardiac depression and microvascular dysfunction) | Treat underlying infection | Use intravenous antibiotics (after sampling for microbiology) |
Push for urgent surgical/interventional source control | ||
Reduce cytokine load | Consider low-dose steroids | |
Consider extra-corporeal cytokine removal |