NYSORA News

Sepsis, a life-threatening organ dysfunction due to a dysregulated host response to infection, requires prompt antimicrobial therapy, source control, and correction of hemodynamic abnormalities. Managing sepsis-induced hemodynamic changes is critical to improving patient outcomes. This review presents evidence-based recommendations for fluid resuscitation, vasopressor use, and hemodynamic targets in adults with sepsis. Key recommendations for hemodynamic support in sepsis Fluid resuscitation Initial fluid therapy: Administer 30 ml/kg of crystalloids within the first 3 hours of sepsis, based on 2021 Surviving Sepsis Campaign guidelines. Tailor fluid administration using hemodynamic monitoring (e.g., echocardiography, dynamic parameters) to avoid overresuscitation. Restrictive vs. Liberal fluid therapy: The CLASSIC trial found no difference in 90-day mortality between restrictive and standard fluid therapy in septic shock. The CLOVERS trial showed no mortality difference between restrictive and liberal fluid strategies but noted earlier vasopressor use in the restrictive group. Fluid responsiveness: Approximately 30% of septic shock patients are non-responders to fluids. Dynamic tests like passive leg raise and end-expiratory occlusion test predict fluid responsiveness and help limit unnecessary fluid administration. Choice of fluids Balanced crystalloids (Lactated Ringer’s, Plasmalyte): Preferred over normal saline to reduce the risk of hyperchloremic metabolic acidosis and improve kidney function. The SMART trial showed fewer major adverse kidney events and lower mortality in sepsis patients receiving balanced crystalloids. Albumin: Hyper-oncotic albumin may reduce fluid balance but has not shown a significant mortality benefit in sepsis. The ALBIOS trial found a mortality reduction in septic shock patients but not in the broader sepsis population. Vasopressor therapy When to start: Initiate norepinephrine as the first-line vasopressor when MAP < 65 mmHg, even if fluid resuscitation is incomplete. Early vasopressor use reduces fluid balance and improves shock control without increasing adverse effects. Peripheral vasopressors: Safe for short-term use in peripheral veins, with a low risk of local complications. […]

NYSORA News

NYSORA is proud to announce the launch of its new Anesthesia Assistant App—a comprehensive digital tool that combines the latest clinical updates in anesthesia practice with NYSORA-trained AI technology. Designed to support anesthesia professionals, nurses, pain specialists, and perioperative physicians, the app brings a suite of practical features to enhance patient care: Digital Anesthesia Assistant Leveraging NYSORA’s peer-reviewed content, this all-in-one tool streamlines access to critical information, eliminating the need to consult multiple sources and enabling faster, more informed decision-making at the point of care. Key Features Include: DoseCalc: Quickly access precise details on medication indications, contraindications, dilution formulas, infusion rates, and maximum dosage recommendations. Case Manager: Receive a structured, step-by-step anesthetic and perioperative analgesia plan tailored to each patient’s unique pathology, lab results, imaging, and medical history. Updates in Anesthesiology & Pain Medicine: Stay informed with real-time notifications on the latest breakthroughs in anesthesiology, critical care, and pain medicine. With over 500,000 medical professionals already relying on NYSORA’s educational resources, the Anesthesia Assistant App is set to become the go-to tool for anesthesia providers worldwide. What truly sets this app apart is its foundation in NYSORA’s peer-reviewed content, continuously refined and updated by a dedicated community of experts—ensuring unparalleled accuracy and reliability. Download the App Today Experience the future of anesthesia education and decision-making. Download the app today.