Early Vasopressors in Sepsis
This is an open label, two arm randomised trial to determine whether early peripheral vasopressor infusion, targeted to MAP>65 , improves clinical effectiveness in hospitalised adult patients with septic shock compared with usual care, in the first 48 hours.
Current guidelines highlight the importance of early fluid resuscitation, but the association of early fluid therapy with improved outcomes is unclear. In the resuscitation phase, current practice is to give liberal intravenous fluid and
intermittent vasopressor boluses if required, before, for some patients, continuous vasopressor infusion via a central venous line in Intensive Care. An alternative, early continuous peripheral vasopressor infusion is not routine practice in the UK
Patient observational data and laboratory experimental medicine support the hypothesis that restriction of IV fluid during the resuscitation phase for septic shock patients, and maintenance of organ perfusion with vasopressors may improve outcomes.
The study aims to recruit 3286 patients who meet the following inclusion criteria:
- Age >18 years
- Clinically suspected or proven infection resulting in principal reason for acute illness
- SBP <90 mmHg or MAP < 65 mmHg and measured serum lactate of > 2 mmol/L at the time of eligibility assessment
- Hospital presentation within last 12 hours