ACS Stroke Sepsis

Early Goal-Directed Therapy (Sepsis) Program

Steroids

1. Consider corticosteroids in septic shock poorly responding to pressors and fluid resuscitation (2C).
2. ACTH stim test is not recommended to ID a population that should receive hydrocortisone (2B).
3. Hydrocortisone is preferred over dexamethasone (2B).
4. Fludrocortisone is optional if hydrocortisone is used. If an alternative to hydrocortisone is used that lacks mineralocorticoid activity, Fludrocortisone (50mcg daily) may be used (2C).
5. Steroids may be weaned once pressors are no longer needed (2D).
6. Hydrocortisone dose should be less than 300mg per day (1A).
7. In the absence of shock, do not treat with steroids unless the pts history indicates (1D).

Select Abbreviations Antibiotics APACHE II Bicarbonate Therapy Diagnosis DVT Prophylaxis Fluid Therapy Glucose Control Inotropic Support Levels Of Evidence Mechanical Ventilation of ALI/ARDS References Renal Replacement Sedation and Analgesia Sepsis Criteria Sepsis Definitions Source ID and Control Steroids Stress Ulcer Prophylaxis Vasopressors Xigris Indications

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