What should be completed within 6 hours of sepsis/septic shock resuscitation?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

The following should be completed within 6 hours:

  • Administer vasopressors for hypotension that does not respond to initial fluid resuscitation to maintain a mean arterial pressure (MAP) of 65 mm Hg or higher (Recent studies showed the validity of the 70-75 mm Hg lower mean arterial pressure target or 80-85 mm Hg in those patients with preexisting hypertension.)

  • If hypotension persists despite volume resuscitation or the initial lactate level is 4 mmol/L or higher, then measure central venous pressure (CVP) (aiming for ≥8 mm Hg), measure central venous oxygen saturation (ScvO2) (aiming for ≥70%), and normalize lactate levels (These recommendations will probably be modified in lieu of the findings that CVP does not represent an effective target. See below about the venoarterial PCO2 gradient analysis as being a more specific measure of tissue hypoperfusion.)


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