Initial resuscitation / inotropes

Abstract

The pathogenesis of septic shock includes not only a relative decrease in intravascular volume associated with vasodilatation and vascular permeability, but may also be mixed with sepsis induced myocardial dysfunction. Since it is necessary to accurately assess the pathophysiology and select an appropriate treatment for each individual case, the J-SSCG 2020 recommends that when a septic patient is encountered, a simple cardiac and vascular echocardiography should first be performed to assess preload and cardiac function. For decreased in intravascular volume, initial fluid resuscitation is recommended, noradrenaline is administered if it is determined that the patient is in shock due to vasodilation, and if blood pressure still cannot be maintained, additional vasopressin is recommended. On the other hand, if cardiac dysfunction is detected by echocardiography, inotropic drugs are necessary, β1 receptor blockers are recommended for tachyarrhythmias, and indications for assisted circulation are being considered for severe cardiac dysfunction. This paper will discuss the CQ/Answer and medical treatment flow presented by the J-SSCG 2020 regarding initial resuscitation and inotropes for patients with septic shock.