The critical care nurse is delivering a peer lecture on guidelines for the management of SIRS and severe sepsis. Current evidence suggests which of the following will improve outcome in septic shock?
1. Maintain blood glucose between 110 and 134 mg/dL
2. Antibiotic therapy initiated prior to end of shift
3. Mechanical ventilation with tidal volume of 10 ml/kg
4. Bicarbonate used for pH of 7.30
Maintain blood glucose between 110 and 134 mg/dL
Rationale: Current evidence indicates that maintaining blood glucose <150 mg/dL improves lipid levels and has anti-inflammatory and anticoagulant properties, improving chances of survival. Antibiotic therapy should be initiated within the first hour of identifying sepsis. Mechanical ventilation with tidal volumes of 4 to 6 liters/kg of normal body weight improves outcome. Bicarbonate is not routinely used for acidosis.
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