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Table 4 Summary of the expert’s recommendations and its degree of consensus and grade of recommendation

From: Current use of vasopressors in septic shock

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
  1. Definitions of degree of consensus and grades of recommendations based on the RAND algorithm. All 34 experts in agreement defined a perfect consensus and experts ≥ 80% agreement defined good consensus; both were considered as strong recommendation. Reasonable consensus was defined as 70–80% agreement among experts, and the recommendation was considered to be conditional