Date of Award

2019

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

First Advisor

Meredith Wold

Abstract

Sepsis and septic shock is a disease process that carries a high mortality rate and is responsible for a large portion of healthcare expenditures in the United States. The Surviving Sepsis Campaign has been working to decrease the mortality of sepsis since 2001. Their mission is two-fold; providing evidence based guidelines to help direct treatment, and raising awareness to healthcare providers and patients about sepsis. A main goal in treating sepsis is to reverse the hypoperfused state by giving crystalloid fluids and administering vasopressors, specifically norepinephrine, after patients have received adequate fluids. Would modifying this treatment by giving a combination of vasopressors, instead of the current recommendation of just norepinephrine, earlier decrease the mortality of patients in septic shock?

After performing a literature search on PubMed and Google Scholar, 80 articles were found and narrowed down to a total of 32, including randomized control trials, animal trials, retrospective and prospective cohort studies and meta-analyses, were reviewed. Articles looked at norepinephrine, vasopressin, terlipressin, dobutamine, and early vasopressor use.

This literature review found that there is some evidence supporting the early use of combination vasopressor therapy, though more in-depth trials should be performed before making stronger recommendations or changing guidelines. Different patient subgroups appear to have better outcomes based on the different combinations of vasopressors. Norepinephrine continues to be a mainstay of treatment, and patients need to receive crystalloid fluids before and during administration of vasopressors.

Identifier

SC 11.PAS.2019.Kittok.M

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