Less is more: catecholamine-sparing strategies in septic shock
Noradrenaline, a catecholamine, is the first line agent for the management of septic shock  and has been shown to be superior to dopamine  and equivalent to adrenaline  and vasopressin . High doses of catecholamines are frequently required to reverse shock [5, 6]. While the presence of circulatory shock remains a strong and independent predictor of mortality , the use of catecholaminergic agents to reverse shock is associated with adverse events—tachyarrhythmias, thermogenic, metabolic and excess vasoconstriction resulting in tissue ischemia [2, 8]. These adverse effects have led to an interest in adjunctive therapies and catecholamine minimization strategies.
Optimal fluid resuscitation
The first step is optimizing fluid resuscitation. While guidelines recommend optimal filling prior to initiation of vasopressor support , the precise endpoints for fluid resuscitation remain unclear. In resource-limited settings in Africa, fluid boluses significantly increased 48-h...
Prof. Venkatesh is supported by an NHMRC-Medical Research Future Fund Practitioner Fellowship. This work was also supported by an NHMRC grant APP1161182.
Compliance with ethical standards
Conflicts of interest
The authors do not have any financial conflict of interest in association with this manuscript.