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Treatment of Septic Shock in Resource-Limited Settings


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.

 The experts  Recommend following measures for treatment of septic shock in resource-limited settings-
  • 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.

For further Reference log on to :

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

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Dr. Kamal Kant Kohli

Dr. Kamal Kant Kohli

A Medical practitioner with a flair for writing medical articles, Dr Kamal Kant Kohli joined Medical Dialogues as an Editor-in-Chief for the Speciality Medical Dialogues. Before Joining Medical Dialogues, he has served as the Hony. Secretary of the Delhi Medical Association as well as the chairman of Anti-Quackery Committee in Delhi and worked with other Medical Councils of India. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751
Source: self

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