PulmCrit (EMCrit)
PulmCrit - January 30, 2017 - By Josh Farkas
..."The Surviving Sepsis Campaign was founded on the basis of early goal-directed therapy. As this was disproven, the campaign stubbornly clung to it (for example, continuing to recommend CVP monitoring in 2014). The current guidelines have finally removed early goal-directed therapy, since to do otherwise would have rendered them irredeemably obsolete.
However, many vestiges of early goal-directed therapy remain in the current guidelines (e.g. serial lactate measurement). We must take a hard, objective look at such therapies to determine if they still stand up, now that early goal-directed therapy has collapsed...
- Myth #6: Combination therapy is beneficial for gram-negative septic shock.
- Myth #5: Norepinephrine is the best vasopressor for all septic patients.
- Myth #4: If one vasopressor doesn’t work, additional drugs should be added in a sequential fashion.
- Myth #3: Lactate is a measure of tissue perfusion. Normalization of lactate should be used as a resuscitation target.
- Myth #2: All septic patients must receive 30 ml/kg fluid initially.
- Myth #1: It’s helpful to mandate that specific sepsis therapies be given within a rigid time frame."