Emergency Management Protocol

We recommend that treatment and resuscitation begin immediately.

We suggest that at least 30 mL/kg of IV crystalloid fluid should be given within the first 3 hr of resuscitation.

We suggest using dynamic measures to guide fluid resuscitation, over physical examination, or static parameters alone.

We suggest guiding resuscitation to decrease serum lactate in patients with elevated lactate level, over not using serum lactate.

We suggest using capillary refill time to guide resuscitation as an adjunct to other measures of perfusion.

We recommend an initial target mean arterial pressure (MAP) of 65 mm Hg over higher MAP targets.

We suggest admitting the patients to the ICU within 6 hr.

We recommend using norepinephrine as the first-line agent over other vasopressors.

We suggest adding vasopressin instead of escalating the dose of norepinephrine.

We suggest adding epinephrine.

We suggest against using terlipressin.

We suggest either adding dobutamine to norepinephrine or using epinephrine alone.

We suggest against using levosimendan.

We suggest invasive monitoring of arterial blood pressure over noninvasive monitoring, as soon as practical and if resources are available.

We suggest starting vasopressors peripherally to restore mean arterial pressure rather than delaying initiation until a central venous access is secured.