Podcast 598: Sepsis, Round One

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">Early antibiotics have been shown to improve outcomes in septic patients time after time</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Emerging evidence challenges the concept of one-size-fits-all large fluid boluses for septic shock patients and fluid may worsen patients who have underlying sepsis-induced pulmonary capillary leak</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Starting peripheral vasopressors early, and relaxing if fluid resuscitation is successful, is appearing to be a more appropriate strategy than fluids first, then vasopressors</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">CLASSIC Trial Group; Scandinavian Critical Care Trials Group.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/27686349/"><span style= "font-weight: 400;">Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial.</span></a> <span style="font-weight: 400;">Intensive Care Med. 2016 Nov;42(11):1695-1705. doi: 10.1007/s00134-016-4500-7. Epub 2016 Sep 30. PMID: 27686349.</span></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/30704260/"><span style= "font-weight: 400;">Early Use of Norepinephrine in Septic Shock Resuscitation <span style="font-size: 10pt;">(CENSER). A Randomized Trial.</span></span></a> <span style="font-weight: 400;">Am J Respir Crit Care Med. 2019 May 1;199(9):1097-1105. doi: 10.1164/rccm.201806-1034OC. PMID: 30704260.</span></span></p> <p><span style="font-size: 10pt;"><em><span style= "font-weight: 400;">Summarized by Jackson Roos, MS4 | Edited by Eri