Publication: Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings
Issued Date
2017-11-01
Resource Type
ISSN
18783503
00359203
00359203
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2-s2.0-85042924110
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Mahidol University
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SCOPUS
Bibliographic Citation
Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.111, No.11 (2017), 483-489
Suggested Citation
David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W. Dünser, Arjen M. Dondorp, Marcus J. Schultz Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings. Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.111, No.11 (2017), 483-489. doi:10.1093/trstmh/try007 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/42739
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Title
Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings
Abstract
© The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking. Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind. Results: We suggest using capillary refill time, skin mottling scores and skin temperature gradients; suggest a passive leg raise test to guide fluid resuscitation; recommend crystalloid solutions as the initial fluid of choice; recommend initial fluid resuscitation with 30 ml/kg in the first 3 h, but with extreme caution in settings where there is a lack ofmechanical ventilation; recommend against an early start of vasopressors; suggest starting a vasopressor in patients with persistent hypotension after initial fluid resuscitation with at least 30ml/kg, but earlier when there is lack of vasopressors and mechanical ventilation; recommend using norepinephrine (noradrenaline) as a first-line vasopressor; suggest starting an inotrope with persistence of plasma lactate >2 mmol/L or persistence of skin mottling or prolonged capillary refill time when plasma lactate cannot be measured, and only after initial fluid resuscitation; suggest the use of dobutamine as a first-line inotrope; recommend administering vasopressors through a central venous line and suggest administering vasopressors and inotropes via a central venous line using a syringe or infusion pump when available. Conclusion: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings have been developed by a task force of six international experts in critical care medicine with extensive practical experience in resource-limited settings.