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Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings
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 Europea...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914406/ https://www.ncbi.nlm.nih.gov/pubmed/29438568 http://dx.doi.org/10.1093/trstmh/try007 |
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author | Misango, David Pattnaik, Rajyabardhan Baker, Tim Dünser, Martin W Dondorp, Arjen M Schultz, Marcus J |
author_facet | Misango, David Pattnaik, Rajyabardhan Baker, Tim Dünser, Martin W Dondorp, Arjen M Schultz, Marcus J |
author_sort | Misango, David |
collection | PubMed |
description | 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 of mechanical ventilation; recommend against an early start of vasopressors; suggest starting a vasopressor in patients with persistent hypotension after initial fluid resuscitation with at least 30 ml/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. |
format | Online Article Text |
id | pubmed-5914406 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-59144062018-05-04 Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings Misango, David Pattnaik, Rajyabardhan Baker, Tim Dünser, Martin W Dondorp, Arjen M Schultz, Marcus J Trans R Soc Trop Med Hyg Review 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 of mechanical ventilation; recommend against an early start of vasopressors; suggest starting a vasopressor in patients with persistent hypotension after initial fluid resuscitation with at least 30 ml/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. Oxford University Press 2017-11 2018-02-09 /pmc/articles/PMC5914406/ /pubmed/29438568 http://dx.doi.org/10.1093/trstmh/try007 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Misango, David Pattnaik, Rajyabardhan Baker, Tim Dünser, Martin W Dondorp, Arjen M Schultz, Marcus J Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings |
title | Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings |
title_full | Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings |
title_fullStr | Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings |
title_full_unstemmed | Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings |
title_short | Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings |
title_sort | haemodynamic assessment and support in sepsis and septic shock in resource-limited settings |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914406/ https://www.ncbi.nlm.nih.gov/pubmed/29438568 http://dx.doi.org/10.1093/trstmh/try007 |
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