A 45-year-old woman with septic shock secondary to pyelonephritis has received 30 mL/kg crystalloid bolus. MAP is 58 mmHg with lactate 5.2 mmol/L. Norepinephrine is started. According to the Surviving Sepsis Campaign guidelines, what is the target mean arterial pressure (MAP) for initial resuscitation?

• A MAP ≥50 mmHg
• B MAP ≥65 mmHg ✓
• C MAP ≥75 mmHg
• D MAP ≥80 mmHg

Explanation

The Surviving Sepsis Campaign (2021) recommends an initial target MAP of 65 mmHg in patients with septic shock requiring vasopressors. The SEPSISPAM trial showed that targeting higher MAP (80-85) did not improve mortality and was associated with more atrial fibrillation. Norepinephrine remains the first-line vasopressor.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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