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Comment & Response |

Definitions for Sepsis and Septic Shock

Shivinder Singh, MD1; Sanil Mohan, MD1; Ravi Singhal, MD1
[+] Author Affiliations
1Department of Anesthesiology and Critical Care, Command Hospital Western Command Chandimandir, Panchkula, Haryana, India
JAMA. 2016;316(4):458. doi:10.1001/jama.2016.6368.
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To the Editor The Sepsis-3 definition of sepsis1 includes the SOFA score.2 The SOFA scoring system has stood the test of time as a simple, readily reproducible scoring system to monitor the progress of sepsis patients, and its place in clinical evaluation is undisputed.

The Surviving Sepsis Campaign guidelines3 recommend norepinephrine as the first-choice vasopressor to maintain mean arterial pressure 65 mm Hg or higher, with epinephrine used when an additional agent is needed to maintain adequate blood pressure. Dopamine is not recommended except in selected circumstances. Dobutamine infusion can be administered or added to other vasopressors in the presence of myocardial dysfunction or ongoing signs of hypoperfusion despite achieving adequate intravascular volume and mean arterial pressure. The vasopressor of first choice in septic shock is norepinephrine followed by epinephrine.


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July 26, 2016
Clifford S. Deutschman, MD, MS; Mervyn Singer, MD, FRCP
1Center for Pediatric Research, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
2Bloomsburg Institute of Intensive Care Medicine, University College London, London, United Kingdom
JAMA. 2016;316(4):458-459. doi:10.1001/jama.2016.6389.
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