Sepsis: Next-Line Management When Initial Resuscitation Fails to Decrease Serum Lactate
When sepsis is identified and the first-line response — immediate fluid resuscitation, empiric antimicrobials, and source control — does not achieve the key resuscitation goal, a structured next step is required to stabilise the patient's haemodynamics.
Prior Treatment and Its Unmet Goal
What was tried first
The initial line consists of prompt IV crystalloid fluid resuscitation, immediate empiric antimicrobial administration, and timely source control intervention.
Why escalation is indicated The target of that line — guiding resuscitation to decrease serum lactate in patients with an elevated lactate level — was not achieved, triggering escalation to this protocol.
Why escalation is indicated The target of that line — guiding resuscitation to decrease serum lactate in patients with an elevated lactate level — was not achieved, triggering escalation to this protocol.
Next Step
References
DOI: 10.1097/CCM.0000000000005337
- For adults with septic shock, we recommend using norepinephrine as the first-line agent over other vasopressors.
- For adults with septic shock on vasopressors, we recommend an initial target mean arterial pressure (MAP) of 65 mm Hg over higher MAP targets.
- In settings where norepinephrine is not available, epinephrine or dopamine can be used as an alternative, but we encourage efforts to improve the availability of norepinephrine.