Prise en charge du sepsis grave et du choc septique : survivre au sepsis

Septic shock is still associated with a high mortality. An optimal initial management of patients with septic shock has been demonstrated to be associated with a significant reduction in hospital mortality. This review presents an updated information on the initial management of septic shock. Correction of fluid deficit should be the first step. Crystalloids are to be preferred to colloids. A balanced crystalloid solution should be used. When colloids are used, hydroxy-ethyl-starch solutions must not be used and human albumin solutions should be preferred. The use of a potent vasopressor is always needed. Norepinephrine is the first choice and epinephrine can be an alternative. A mean arterial pressure level around 65 mmHg should be targeted. When cardiac dysfunction is diagnosed, dobutamine is prescribed, associated with norepinephrine. Lactate levels and ScvO2 must be measured. A decrease by 10% of lactate level is associated with an improved prognosis. ScvO2 between 70 and 75% should be targeted.