Vasopressin is often recommended as a second-line pressor or to reduce the dose of norepinephrine in humans, but it is often unavailable to veterinary patients due to cost.
Epinephrine; 0.05-mcg/kg/min. This can be added to norepinephrine if needed and titrated upwards every 5-10 minutes until BP targets are reached.
Dopamine has historically been the pressor of choice in veterinary patients, but recent practice has shifted to norepinephrine based largely on extrapolation from research in human sepsis patients.
Dobutamine is primarily an inotrope and is only recommended if there is evidence of poor contractility because it decreases vascular tone and can decrease BP.
Goal-directed monitoring and treatment of key physiologic parameters. It is important to identify all physiologic abnormalities that can be treated in patients with sepsis and septic shock. These may include:
- Electrolytes
- Blood glucose
- Lactate
- Packed cell volume/total protein/albumin
- Coagulation: prothrombin time/partial thromboplastin time/platelet counts
- Blood pressure
- Vital signs: heart rate, respiratory rate, body temperature, pulse quality, mucous membrane color, capillary refill time
- SPO2
- ECG
- Pain score and mental status. Analgesia should be provided if there is evidence of pain. Non-steroidal anti-inflammatory drugs should be avoided if there is hemodynamic instability or evidence of gastrointestinal or renal impairments.
- Urine output and renal values.
- Body weight. This is a key measure for assessing fluid balance.
Source control. Once a patient has achieved hemodynamic stability, early control of the infection source is recommended. Surgical treatment of septic foci should be performed as soon as the patient is reasonably stable for the procedure.
