Sepsis

Question 1

What is septic shock?

Answer 1

Septic shock is a type of distributive shock that occurs due to a
widespread inflammatory response.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1589

Question 2

What is the indication for the administration of

recombinant activated protein C?

Answer 2

Recombinant activated protein C should be administered if the
patient is at a high risk of death.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1593.

Question 3

When should steroids be used in the treatment of

sepsis?

Answer 3

Steroids may be administered in patients whose blood pressure
does not respond adequately to fluid resuscitation and pressors.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1591.

Question 4

How do the roles of norepinephrine, dopamine,
vasopressin, and dobutamine compare in the
treatment of sepsis?

Answer 4

Norepinephrine and dopamine are considered the first-line
treatments in sepsis to achieve a mean arterial pressure of 65
mmHg or greater. Vasopressin may be used at a fixed rate as
an adjunct to norepinephrine and dopamine if needed. Lowdose
dopamine for ‘renal protection’ is not recommended for
these patients. If the patient exhibits a low cardiac output
despite fluid resuscitation, dobutamine may be used.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1591.

Question 5

What ventilator settings are most appropriate for the

patient in septic shock?

Answer 5

The current recommended protocol is a low tidal volume, low
inspiratory pressure, and the application of PEEP.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1591

Question 6

What organ system is most susceptible to ischemia

from septic shock?

Answer 6

Because of the redistribution of blood that occurs in septic
shock, the gastrointestinal tract is the most susceptible to
ischemia.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1589.

Question 7

How does septic shock affect acid-base balance?

Answer 7

Because of an increased metabolic demand and an inability to
perfuse tissues adequately, there is often a metabolic acidosis
present.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1589-1590.

Question 8

How is cardiac contractility affected by septic shock?

Answer 8

There is an overall decrease in cardiac contractility.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1589

Question 9

What are the cardiovascular changes associated

with septic shock?

Answer 9

High cardiac output, low systemic vascular resistance,
hypotension, and tissue underperfusion.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1589.

Question 10

A patient in septic shock has a pH of 7.2. Should

sodium bicarbonate be administered?

Answer 10

No. Patients in septic shock with a pH higher than 7.15 should
not be given sodium bicarbonate.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1591.