emDocs - September 4, 2017 - Author: Fox W - Edited by: Koyfman A and Long B
"Conclusion
The understanding and adoption of fluid resuscitation in patients with sepsis has improved outcomes and the level of care so much so that provider compensation may now be tied to meeting certain metrics guiding resuscitation. Though providers may find solace in the relative simplification of sepsis treatment regimens, adopting therapies as a panacea without critical thought and applicability will inevitably doom complicated or outlier patients to substandard or dangerous care. The goal of this review is to understand the implications of chronic physiologic abnormalities that can confound providers and limit the effectiveness of the “standard of care”. An understanding of these nuances of end-organ disease can give providers a general framework to approach the care of complicated sepsis cases in an intelligent, methodical, and patient-centered manner.
Take Home Points
- Despite comorbidities, sepsis is the primary threat to the life of the patient and must be treated
- SBP should not be overlooked in cirrhotic, and valuable culture data can be gleaned from inoculating culture bottles immediately after sample collection
- Early vasopressor usage in pulmonary hypertension and avoidance of positive pressure ventilation can preserve compromised right ventricular function
- Congestive heart failure patients, conversely, may benefit from positive pressure ventilation used judiciously during resuscitation"