Management of Septic Shock Patients

Management of patients with severe sepsis and septic shock was guided by our local protocol, adapted from international guidelines [15 (link)]. In patients with septic shock, intravenous volume expansion was provided to achieve predefined endpoints: pulse pressure variation <13 % [16 (link)], no response to passive leg raising [17 (link)] or no respiratory variations of the inferior vena cava diameter [18 (link)]. Norepinephrine was used in a stepwise manner to achieve predefined endpoints: mean arterial pressure (MAP) ≥65 mmHg and urine output ≥0.5 mL/kg/h. All patients were investigated with transthoracic echocardiography (Vivid 7 Dimension’06, GE, Healthcare^®). When a cardiac dysfunction (left ejection fraction <30 % by Simpson’s biplane methodology) was identified, an inotropic therapy was introduced and/or epinephrine replaced norepinephrine. Ventilation support was provided when needed. If required, patients were sedated with propofol and/or midazolam and analgesia provided with sufentanil. Use of low doses hydrocortisone (200 mg/day) was considered when there was persistence of vasopressors requirement despite a perceived adequate intravascular volume. Glycemic control and venous thrombosis prophylaxis were provided according to Surviving Sepsis Campaign Guidelines [15 (link)].