Vasopressors During Sepsis : Selection and Targets - 25/05/16

Doi : 10.1016/j.ccm.2016.01.008

Jean P. Gelinas, MD ^a, James A. Russell, MD ^a,^b,^⁎
^a Centre for Heart Lung Innovation, St. Paul’s Hospital, Department of Medicine, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
^b Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada

^∗Corresponding author. Centre for Heart Lung Innovation, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.Centre for Heart Lung InnovationSt. Paul’s Hospital1081 Burrard StreetVancouverBritish ColumbiaV6Z 1Y6Canada

Résumé

Clinicians have greatly improved care for septic shock. Urgent resuscitation using intravenous fluids and vasopressors as well as rapid administration of broad spectrum antibiotics are probably the most basic and universally accepted interventions. Various trials have compared different types of vasopressors, associations of vasopressors and inotropes, and pressure targets. End goal-directed therapy algorithms are designed to optimize oxygen delivery by use of fluids, vasopressors, inotropes, and blood products. Patients who have a poor response to resuscitation and patients with known severe ventricular dysfunction might merit advanced hemodynamic monitoring. This review examines important vasopressor and septic shock trials.

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Keywords : Vasopressors, Norepinephrine, Epinephrine, Vasopressin, Dobutamine, Milrinone, Septic shock, Sepsis