Facharzt FMH Intensivmedizin Practice Questions - Facharzt FMH Für Intensivmedizin Spécialiste FMH En Médecine Intensive Exam

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A 68-year-old man is admitted to the ICU with septic shock secondary to acute ascending cholangitis. After receiving 30 mL/kg of balanced crystalloids, his mean arterial pressure (MAP) is 52 mmHg, heart rate is 118 bpm, and central venous lactate is 4.2 mmol/L. Bedside echocardiography demonstrates a hyperdynamic left ventricle without pericardial effusion. According to the Surviving Sepsis Campaign (SSC) guidelines, what is the initial vasopressor strategy of choice?

Initiate norepinephrine as the first-line vasopressor to target a MAP ≥ 65 mmHg, and add vasopressin (0.03 units/min) if norepinephrine dosage escalates Initiate dopamine monotherapy at 10-20 mcg/kg/min to increase both systemic vascular resistance and renal blood flow Start phenylephrine infusion as the first-line agent to avoid worsening tachycardia while achieving vasoconstriction Administer epinephrine monotherapy as the first-line vasopressor before attempting any other catecholamine

Correct Answer:

Initiate norepinephrine as the first-line vasopressor to target a MAP ≥ 65 mmHg, and add vasopressin (0.03 units/min) if norepinephrine dosage escalates

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