A post-operative patient in the ICU develops oliguria, hypotension, and a raised lactate of 5.2 mmol/L despite adequate volume resuscitation. He is septic with an intra-abdominal collection. The Surviving Sepsis Campaign recommends initial fluid resuscitation. Which fluid and target should be used for initial resuscitation in septic shock?

• A 30 mL/kg 5% dextrose within 3 hours targeting MAP >65 mmHg
• B 20 mL/kg 4.5% human albumin within 1 hour targeting CVP >12 mmHg
• C 10 mL/kg crystalloid boluses titrated to urine output >0.5 mL/kg/hr only
• D 30 mL/kg balanced crystalloid (Ringer's lactate or Hartmann's) within 3 hours targeting MAP >65 mmHg ✓

Explanation

The Surviving Sepsis Campaign guidelines recommend at least 30 mL/kg intravenous balanced crystalloid (Ringer's lactate, Hartmann's, or Plasma-Lyte) within the first 3 hours for initial resuscitation of septic shock, targeting a mean arterial pressure ≥65 mmHg. Balanced crystalloids are preferred over 0.9% normal saline to avoid hyperchloraemic metabolic acidosis. CVP targeting has been abandoned as evidence does not support it as a resuscitation endpoint. If haemodynamic instability persists after fluid resuscitation, noradrenaline is the first-line vasopressor.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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