Table 4 Summary of the expert’s recommendations and its degree of consensus and grade of recommendation
Statement | Degree of consensus | Grade of recommendation |
|---|---|---|
Blood pressure monitoring | ||
1. In patients with shock, arterial blood pressure should be monitored invasively and continuously via an arterial catheter | Perfect | Strong |
Ideal moment to start vasopressor therapy in treating circulatory shock | ||
2. Vasopressors should be started early, before (complete) completion of fluid resuscitation | Reasonable | Conditional |
3. MAP or the combination of MAP and DAP should be considered as trigger to start vasopressor treatment | Good | Strong |
Vasopressor of first choice | ||
4. Norepinephrine should be used as vasopressor of first choice | Perfect | Strong |
Target of vasopressor treatment | ||
5. The target of vasopressor therapy should be a MAP of 65 mmHg | Good | Strong |
6. Lower MAPs are tolerated in case of refractory hypotension despite adequate fluid and vasopressor treatment | Good | Strong |
Treatment options in refractory hypotension | ||
7. Adding a second vasopressor in case of refractory hypotension | Good | Strong |
8. Using vasopressin or terlipressin as second vasopressor | Good | Strong |
Reason to stop vasopressor treatment | ||
9. Vasopressor treatment should be reduced/stopped when the patient improves clinically, when side effects occur, or in case of ineffectiveness | Perfect | Strong |
Use of steroids to reach target | ||
10. Steroids should be considered in septic shock | Good | Strong |