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Table 1 Decatecholaminisation strategies for patients with septic shock

From: Decatecholaminisation during sepsis

 

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 70 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

  1. Evidence and class of recommendations vary between the different interventions