Critical Care Medicine

Answer 1 Rapidly administer 500 mL of normal saline through a large-bore IV line. This patient is most likely in septic shock following bladder catheterization. In the early phases of fluid resuscitation in a septic patient, rapid volume expansion is the key to achieving a good outcome. Adequate and early volume expansion is generally more important than immediate insertion of a central venous catheter or a pulmonary artery catheter if adequate peripheral access is available. The choice of fluid administered is not as critical as early volume expansion.1,2 The target mean arterial blood pressure is 65 mm Hg or greater.3 Pressor therapy may be necessary later; however, adequate volume replacement would be necessary initially to Òprime the pumpÓ for more effective pressor function. REFERENCES 1. Hollenberg SM, Ahrens TS, Annane D, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004;32:1928-48. 2. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. American Thoracic Society. Am J Respir Crit Care Med 2004;170:1247-59. 3. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. N Engl J Med 2001;345:1368-77. Click here to return to the questions

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