Management of septicaemic shock

Seek expert advice

Initial Resuscitation Protocol

• initiate IV fluid resuscitation immediately in patients categorized as high risk for sepsis or presenting with lactate > 2 mmol/L (1)
• use isotonic crystalloids; balanced crystalloids (for example Plasma-Lyte or Hartmann's) are preferred over 0.9% sodium chloride to prevent hyperchloraemic metabolic acidosis (1)
• administer fluids in 250 ml boluses over 10–15 minutes (1)

Monitoring and Reassessment reassess clinical response immediately after completing each 250 ml bolus (1):

• blood pressure and mean arterial pressure (target MAP >= 65 mmHg)
• heart rate and capillary refill time
• mental status and urine output
• repeat blood lactate

Escalation and Volume Ceilings

• 1,000 ml cumulative limit: do not administer more than 1,000 ml of fluid in total without mandatory review and formal approval by a senior clinical decision-maker (FY2+ or consultant) and critical care team (1)
• if patient remains hypotensive or lactate remains elevated despite 1,000 ml fluid resuscitation, evaluate for vasopressor support (1)

Vasopressors

• discuss early with critical care or senior decision-maker if blood pressure fails to respond to initial fluid boluses
• peripheral vasopressor administration (for example noradrenaline via dedicated peripheral line) may be initiated early if central venous access is unavailable or delayed (1)

References

1. National Institute for Health and Care Excellence (NICE). Suspected sepsis in people aged 16 or over: recognition, assessment and early management (NG253). Published Nov 2025, updated Sep 2026.