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Welcome to the inaugural module of ALiEM CAPSULES. The focus of this module is to review the pharmacotherapy of some of the sickest patients encountered in the emergency department. The learning objectives for this module are to:

  • Review the pharmacologic profile of medications utilized in the resuscitation of patients with severe sepsis and septic shock
  • Understand the core principles in the approach to antimicrobial therapy for septic patients
  • Design individualized medication therapy regimens for septic patients
  • Apply knowledge of evidence-based practices to a patient case
Role Team Member Background
Authors Jill Logan, PharmD, BCPS
@EMPharm
Emergency Medicine Pharmacist, University of Maryland Medical Center
Adam Spaulding, PharmD, BCPS
@PharmERAtom
Emergency Medicine Pharmacist, Boston Medical Center
PharmD Reviewer Craig Cocchio, PharmD, BCPS
@iEMPharmD
Emergency Medicine Pharmacist, Trinity Mother Frances Hospital
Physician Reviewer Michael Winters, MD, FAAEM, FACEP
@critcareguys
Associate Professor of Emergency Medicine and Internal Medicine, University of Maryland
Creator and Lead Editor Bryan Hayes, PharmD, FAACT
@pharmertoxguy
Emergency Medicine Pharmacist, Clinical Associate Professor; University of Maryland

References

  1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for the Management of Severe Sepsis and Septic Shock: 2012. Crit Care Med. 2013;41:580-637.
  2. Kaukonen K-M, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372:1629-38.
  3. Rivers E, Nguyen B, Havstad S, et al. Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. N Eng J Med. 2001;345:1368-77.
  4. Myburgh JA, Mythen MG. Resuscitation Fluids. N Engl J Med. 2013;369:1243-51.
  5. The ARISE Investigators and the ANZICS Clinical Trials Group. Goal-Directed Resuscitation for Patients with Early Septic Shock. N Eng J Med. 2014;371:1496-1506.
  6. The ProCESS Investigators. A Randomized Trial of Protocol-Based Care for Early Septic Shock. N Eng J Med. 2014;370;1683-93.
  7. Mouncey PR, Osborn TM, Power GS, et al. Trial of Early Goal-Directed Resuscitation for Septic Shock. N Eng J Med. 2015. Epub ahead of print.
  8. The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247-56.
  9. Caironi P, Tognoni G, Masson S, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370:1412-21.
  10. Perner A, Haase N, Guttormsen A, et al. Hydroxyethyl starch 130/0.42 versus ringer’s acetate in severe sepsis. N Engl J Med 2012;367:124-34.
  11. Myburgh J, Finfer S, Bellomo R, et al. Hydroxethyl starch or saline for resuscitation in intensive care. N Engl J Med 2012;367:1901-11.
  12. Guidet B, Martinet O, Boulain T, et al. Assessment of hemodynamic efficacy and safety of 6% hydroxyethyl starch 130/0.4 vs 0.9% NaCl fluid replacement in patients with severe sepsis: The Crystmas study. Critical Care 2012;16:R94.
  13. Annane D, Siami S, Jaber S, et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: The Crystal randomized trial. JAMA. 2013;310(17):1809-1817.
  14. Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012 Oct; 308(15):1566-72.
  15. Shaw AD, Bagshaw SM, Goldstein SL, et al. Major complications, mortality and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-lyte. Ann Surg 2012 May;255(5):821-9.
  16. Zhou F, Peng ZY, Bishop JV, et al. Effects of fluid resuscitation with 0.9% saline versus  a balanced electrolyte solution on acute kidney injury in a rat model of sepsis. Crit Care Med 2014 Apr;42(4):e270-8.
  17. Didwania A, Miller J, Kassel D, et al. Effect of intravenous lactated ringer’s solution infusion on the circulating lactate concentration: Part 3. Results of a prospective, randomized, double-blind, placebo-control trial. Crit Care Med. 1997 Nov;25(11):1851-4.
  18. De Backer D, Bliston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010;362:779-89.
  19. Holmes SL, Walley KR. Bad medicine: low-dose dopamine in the ICU. Chest 2003 Apr;123(4):1266-75.
  20. Russel JK, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. Engl J Med 2008;358:877-87.
  21. Ricard JD, Salomon L, Boyer A, et al. Central or peripheral catheters for initial venous access of ICU patients: a randomized controlled trial. Crit Care Med 2013 Sep;41(9):2108-15.
  22. Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008;358:111-24.
  23. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008 Jan;34(1):17-60.
  24. Holst LB, Haase N, Wetterselv J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 2014;371:1381-91.
  25. Campagna JD, Bond MC, Schabelman E, Hayse BD. The use of cephalosporis in penicillin-allergic patients: a literature review. J Emerg Med. 2012;42(5):612-20.
  26. Chambers HF, Elipoulos GM, Gilbert DN, Saags MS, eds. The Sanford Guide to Antimicrobial Therapy, 44th ed. Sperryville, VA: Antimicrobial Therapy; 2014.
  27. Leekha S, Terrell CL, Edson RS. General Principles of Antimicrobial therapy. Mayo Clin Proc. 2011;86(2):156-67.
  28. Safdar N, Handelsman J, Maki DG. Does combination antimicrobial therapy reduce mortality in gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis. 2004; 4:519-27.

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