This handout is for acute hf — sepsis-induced cardiomyopathy (sicm). Your care team identified this based on: severe sepsis or septic shock + new lvef drop ≥10% absolute (or new lvef ≤45%) on echo within 48-72h → sicm pathway.
Other reasons your team may use this plan: troponin elevation in sepsis without ischemic ecg / regional wall motion abnormalities → likely sicm-related demand/depression (rule out type-2 mi); global lv hypokinesis (not regional) on bedside echo during sepsis — pattern favors sicm over ischemic cardiomyopathy; pulmonary edema developing during sepsis resuscitation (>30 ml/kg) — flag sicm + over-resuscitation.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| norepinephrine | 0.05 µg/kg/min titrate to MAP ≥65 (75-85 in chronic HTN per SEPSISPAM) | IV | continuous infusion | SOAP-II PMID 20200382 + SSC 2021 (PMID 34599691) — first-line vasopressor in septic shock; lower arrhythmia risk vs dopamine; preserved coronary perfusion vs phenylephrine |
| vasopressin | 0.03 U/min fixed (NOT titrated) | IV | continuous infusion | VASST PMID 18305265 — catecholamine-sparing add-on; particularly useful in SICM to reduce NE dose + tachyarrhythmia burden |
| dobutamine | 2.5-5 µg/kg/min low-dose (NOT 10-20); titrate by serial echo CI | IV | continuous infusion | SSC 2021 conditional recommendation; β-adrenergic desensitization in SICM means higher doses often ineffective; favor low-dose targeted at CI <2.5; AVOID if no CI evidence (mortality signal in EGDT trials when used routinely) |
| hydrocortisone | 50 mg IV q6h (200 mg/day total) | IV | q6h × 7 days or until pressor-free | ADRENAL PMID 29347874 + APROCCHSS PMID 29490185 — reduces shock duration; modest mortality benefit in pressor-dependent shock; SSC 2021 conditional recommendation |
| vancomycin | 25-30 mg/kg load then 15-20 mg/kg q8-12h (AUC-targeted 400-600) | IV | q8-12h titrate by AUC | IDSA 2020 vancomycin AUC dosing; empirical for MRSA coverage in undifferentiated severe sepsis |
| piperacillin-tazobactam | 4.5 g IV q6h (extended infusion 4h preferred per BLING-III) | IV | q6h extended infusion | Broad gram-negative + anaerobic coverage; extended infusion improves outcomes in severe sepsis per BLING-III |
| sodium chloride 0.9% or balanced crystalloid | 20-30 mL/kg IV bolus over 30-60 min; reassess at 15 mL/kg in SICM with dynamic markers | IV | bolus then maintenance | SSC 2021 30 mL/kg; SMART (PMID 29485925) favors balanced crystalloid; SICM tolerates less volume — reassess at 15 mL/kg with stroke volume variation / passive leg raise / IVC US |
Plan: Sepsis-induced cardiomyopathy — SSC bundle + SICM-modified fluid/inotrope strategy + deferred GDMT (SSC 2021/2026; Beesley 2018; Chen 2014)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
90-day cardiology echo to determine SICM recovery (most do); if persistent dysfunction → start chronic the four foundational heart-failure medications (4 pillars per ACC/AHA 2022); if recovered → educate patient on sepsis-prevention + future risk; ID follow-up for source control adequacy + suppressive abx if applicable
Guideline: Surviving Sepsis Campaign 2021/2026 + Beesley 2018 SICM review + 2022 ACC/AHA HF