Treatment of Septic Shock in Resource-Limited Settings

Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking.In order to fill this void 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.All the members of task force have 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.

• Using capillary refill time, skin mottling scores and skin temperature gradients and 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.

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Transactions of The Royal Society of Tropical Medicine and Hygiene,https://doi.org/10.1093/trstmh/try007