Sun21November0437PM 2

With regard to the resuscitation of patients with septic shock:

True / False

Corticosteroids should be used if a ACTH stimulation test identifies acquired adrenal insufficiency Correct

Albumin should not be used as a resuscitation fluid in septic shock Incorrect answer selected

A maximum of 30 mL/kg of crystalloid should generally be used in the initial resuscitation of septic patients Correct

Colloids, such as 6% hydroxyethyl starch (HES), are more effective than crystalloids Correct

Vasopressin is the first choice of agent if fluid resuscitation alone is insufficient Correct

Explanation

The Surviving Sepsis Campaign updated its guidelines at the beginning of 2016.

In the resuscitation from sepsis-induced hypoperfusion, at least 30ml/kg of intravenous crystalloid fluid be given within the first 3 hours. Following initial fluid resuscitation, additional fluids should be guided by frequent reassessment of hemodynamic status. Crystalloids are the fluids of choice for iniitial resuscitation and subsequent intravascular volume replacement. Albumin may be used in addition to crystalloids when patients require substantial amounts of crystalloids.

An initial target mean arterial pressure of 65 mmHg in patients with septic shock requiring vasopressors. The first choice vasopressor is norepinephrine. Vasopressin can be added (up to 0.03 U/min) or epinephrine to norepinephrine with the intent of raising MAP to target, or adding vasopressin (up to 0.03 U/min) to decrease norepinephrine dosage.

Dynamic measurements of fluid responsiveness should be used in preference to static measurments where available.

Corticosteroids should be avoided if fluid resuscitation and vasopressors alone are sufficient.

The ACTH stimulation test may be confounded by critical illness and supplementation targeted upon the results of it has not been shown to improve outcomes.

Reference:

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Society of Critical Care Medicine and European Society of Intensive Care Medicine.

Answer Statistics

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Average score: 68.13%

Times answered: 288