Vasopressors and Intubation in Septic Shock
Introduction
Septic shock requires rapid restoration of organ perfusion and, when indicated, early definitive airway control. Timely vasopressor support and planned intubation reduce the risk of prolonged hypotension, excessive work of breathing and secondary organ injury.
In the ED these interventions carry governance and safety implications - start interventions promptly, use appropriate routes and equipment, and document escalation to critical care (NICE NG253; Resuscitation Council UK).
Vasopressors
When and why to start
The objective of vasopressors is to restore arterial pressure and perfusion when hypotension persists despite initial fluid resuscitation. Start vasopressors promptly if hypotension or signs of ongoing tissue hypoperfusion continue after initial boluses; do not withhold them solely to await central venous access.
Decisions should involve senior or critical‑care input where feasible (NICE NG253; Resuscitation Council UK).
Target
Use a pragmatic mean arterial pressure (MAP) target of about 60-65 mmHg as a starting goal for most adults. Individualise targets (for example, consider higher targets in patients with chronic hypertension) (Resuscitation Council UK).
Routes and practical principles
- Central venous access is preferable for ongoing vasopressor therapy, monitoring and longer infusions. Arrange ultrasound‑guided central access as soon as practicable.
- Starting noradrenaline peripherally via a visible, proximal, large‑bore cannula (for example, antecubital region) is an accepted short‑term option when central access is not immediately available.