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. 2023 Apr 28;12(9):3188. doi: 10.3390/jcm12093188

Table 3.

Summary of Emergency Physician’s perspectives reported in this manuscript.

Pillars of Treatment Emergency Physician’s Perspectives
Antimicrobials
  • -

    Culture samples are required before administration of antimicrobials;

  • -

    Treatments should be based on clinical/epidemiological criteria and promptly started;

  • -

    Frequent re-assessments of patients’ condition and PCT levels are advisable for an adequate reduction strategy;

  • -

    Short courses of antimicrobial treatments may be indicated.
Fluids
  • -

    Balanced crystalloids are the fluid of choice;

  • -

    Individualized resuscitation strategies based on FT and FR are preferable;

  • -

    Approaches based on small and repeated boluses (250–500 mL) of crystalloids with continuous hemodynamic monitoring are advised.
Vasoactive Agents
  • -

    Vasopressors are required if a patient’s MAP is <65 mmHg despite fluid replacement;

  • -

    NE at a dose of 0.1–1.2 μg/kg/min is the drug of choice for septic patients;

  • -

    Early administration of NE could prevent fluid overload, thereby reducing mortality;

  • -

    VP at a dose of 0.25–0.5 μg/kg/min may be combined with NE if target MAP is not achieved.
Oxygenation and Ventilation Support
  • -

    Oxygenation should be started at 15 L/min via a reservoir mask;

  • -

    The target values for titration should be SpO2 94–98% or SpO2 88–92% if the patient is at risk of hypercapnic respiratory failure;

  • -

    If NIV/MV is needed, a low tidal volume (6 mL/kg) is advisable;

  • -

    HFNC may be used in septic patients with hypoxic respiratory failure.
Other Treatments
  • (1)
    Heparin
    • -
      LMWH rather than UFH should be used to prevent VTE;
    • -
      Mechanical prophylaxis is advised for patients unsuitable for heparin treatment.
  • (2)
    Insulin
    • -
      The use of insulin is advisable to achieve a glucose target between 144–180 mg/dL.
  • (3)
    Proton Pump Inhibitors
    • -
      PPI treatment may be necessary to prevent stress ulcers.
  • (4)
    Renal Replacement Therapy
    • -
      Although AKI is a common complication of sepsis, RRT may only be indicated in some subsets of patients.
  • (5)
    Steroids
    • -
      Hydrocortisone may be considered in patients with vasopressor-resistant, inadequate MAP.
  • (6)
    Sodium Bicarbonate
    • -
      Sodium bicarbonate may be given to patients with severe bicarbonate levels < 5 mEq/L and/or pH < 7.1 or AKI stage 2 or 3.
  • (7)
    Acetaminophen
    • -
      Acetaminophen should be administered as a symptomatic drug.

Note: AKI: acute kidney injury; FR: fluid responsiveness; FT: fluid tolerance; HFNC: high-flow nasal cannula; LMWH: low-molecular-weight heparin; MAP: mean arterial pressure; NE: norepinephrine; PCT: procalcitonin; PPI: proton pump inhibitor; RRT: renal replacement therapy; SSC: surviving sepsis campaign; UFH: unfractionated heparin; VP: vasopressin; VTE: venous thromboembolism.