New practices to increase blood pressure emerge from national sepsis study

New research focusing on improving a standard treatment for septic shock has provided clarity around something that has not been well understood in the past: How to best increase blood pressure during an episode of septic shock.

Because sepsis leads to dangerously low blood pressure, moving to quickly normalize it for a patient experiencing a septic shock is a typical procedure, but now physicians can look to new practices to improve outcomes in this vein.  

"The two basic options for increasing blood pressure are to administer intravenous fluids to increase circulating blood volume or to give vasopressors, which are medications that constrict blood vessels," Wesley Self, MD, of Nashville, Tenn.-based Vanderbilt University Medical Center, senior author of the newly released research, told Becker's. "Both approaches can often achieve the goal of increasing blood pressure, but they each have potential risks as well."

Along with his colleagues, Dr. Self is part of the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis trial which set out to understand if vasopressor use to support blood pressure could lead to better patient outcomes rather than the continued use of additional IV fluid.  

"We found that both vasopressors and continued IV fluid administration worked equally as well," Dr. Self said. "If an adult with septic shock remains hypotensive after about two liters of IV fluid, continuing with additional IV fluid is a safe practice in the absence of signs that the patient is overtly fluid overloaded." 

Dr. Self explained that the research also provided data exhibiting the safety of administering vasopressors through peripheral IV catheters.  

"This had been historically avoided in many settings due to concerns about extravasation and the harm it could cause. However, mandating a central venous catheter for vasopressor administration can substantially delay the initiation of vasopressors," Dr. Self told Becker's. "These data should provide confidence for clinicians to initiate vasopressors through a peripheral IV catheter when they believe vasopressors are urgently needed." 

The CLOVERS trial included 1,563 patients across 60 facilities. The research was funded by the National Heart, Lung and Blood Institute sector of the National Institutes of Health. Dr. Self's findings were published in the New England Journal of Medicine.

Dr. Self told Becker's that while there are many unanswered questions about sepsis treatment, it is vital for future research to prioritize improving patient safety and outcomes. 

Vanderbilt University Medical Center has several ongoing studies looking into different aspects of sepsis, including early recognition and optimizing strategies to identify infectious pathogens as early as possible.

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