It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line. However, available evidence doesn’t support this.
COVID-19 is a pandemic with a rapidly increasing incidence of infections and deaths. Many pharmacologic therapies are being used or considered for treatment. Summarized below are the recommendations with comments related to the clinical practice guideline for the treatment and management of COVID-19.
The choice of crystalloid fluid for volume resuscitation is debated often. With rising concern about the effect of hyperchloremic metabolic acidosis associated with normal saline, clinicians more commonly are opting for balanced crystalloids, such as lactated Ringer’s solution or Plasma-Lyte.
The PLR Maneuver is the only accurate method to date for determining fluid responsiveness
Despite the ongoing controversy regarding the optimal endpoints of early sepsis resuscitation and the source of hyperlactemia, lactate remains the best non-invasive marker of illness severity. Given the current data, a ≥ 10% lactate clearance at 6 hours is an appropriate marker to follow when resuscitating a septic patient. However, recent research by Puskarich et al. showed that lactate normalization to < 2.0 mmol/L within the first 6 hours of resuscitation is superior to the rate of clearance.
