Title: Sepsis Pearls from the Recent Literature<br/>Author: Michael Winters<br/><a href='http://umem.org/profiles/faculty/141/'>[Click to email author]</a><hr/><p>
<u><strong>Sepsis Pearls from the Recent Literature</strong></u></p>
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Sepsis remains one of the most common critical illnesses managed by emergency physicians and intensivists.</li>
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Recent publications and meta-analyses (i.e., ProCESS, ALBIOS, SEPSISPAM) have further refined the management of these complex patients.</li>
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A few pearls from the recent literature:
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<u>Early broad-spectrum antibiotics</u> remains the most important factor in reducing morbidity and mortality.</li>
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<u>Appropriate fluid resuscitation</u> with a balanced crystalloid solution targeting 30 ml/kg. Use a dynamic measure of volume responsiveness to determine if additional fluid needed (i.e., PLR with a minimally invasive or noninvasive cardiac output monitor)</li>
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<u>Maintain adequate tissue perfusion</u> with IVFs and vasopressors (norepinephrine) targeting a MAP > 65 mm Hg. Patients with chronic HTN may benefit from a higher MAP goal. If the diastolic BP is < 40 mm Hg upon presentation, start vasopressors concurrent with IVF resuscitation.</li>
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<fieldset><legend>References</legend>
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Marik PE. Early management of severe sepsis: concepts and controversies. <em>Chest</em> 2014; 145:1407-18.</li>
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Rochwerg B, et al. Fluid resuscitation in sepsis: a systematic review and network meta-analysis. <em>Ann Intern Med</em> 2014 [epub ahead of print]</li>
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Raghunathan K, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. <em>Crit Care Med </em>2014; 42:1585-91.</li>
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