Septic Shock: What to Do When Epinephrine Fails to Achieve the Target Mean Arterial Pressure
Septic shock frequently requires escalating vasopressor support. When a prior vasopressor agent has been added but haemodynamic goals are still not met, a clearly defined next-line protocol applies. This page describes that clinical situation and the direction of management.
Previous Treatment — Goals Not Achieved
Epinephrine was added as the preceding vasopressor step. Despite this, the target mean arterial pressure (MAP) of 65 mm Hg was not achieved. Failure to reach this haemodynamic threshold is the trigger that escalates management to the current protocol.
Next-Line Approach
When vasopressor therapy is ongoing and the MAP target remains unmet, an adjunctive intervention from the corticosteroid class is considered in this setting. The specific agent, its administration, and the full structured regimen are available in the complete protocol.
References
- For adults with septic shock and an ongoing requirement for vasopressor therapy we suggest using IV corticosteroids.
- The typical corticosteroid used in adults with septic shock is IV hydrocortisone at a dose of 200 mg/d given as 50 mg intravenously every 6 hours or as a continuous infusion.
DOI: 10.1097/CCM.0000000000005337
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