Therapy		Clinical use	Evidence	Comments
Bicarbonate therapy		Generally not recommended to improve hemodynamics	Not recommended in patients with hypoperfusion-induced lactic acidemia with pH ≥ 7.1523	Associated with sodium and fluid overload and increased lactate levels
Blood product therapy
	Packed red blood cells	Recommended to achieve hematocrit level ≥ 30% when central venous oxygen saturation is < 70% after restoring mean arterial pressure	Transfusion in early sepsis as part of the early goal-directed therapy is associated with improved outcomes16	Study evaluating survival in the latter course of critical care found no significant difference in mortality rates between the use of a restrictive transfusion trigger (hemoglobin level < 7 g per dL [70 g per L]) and a liberal transfusion trigger (hemoglobin < 10 g per dL [100 g per L])32
	Platelets	Administer when platelet count < 5 × 103 per μL (5 × 109 per L), regardless of bleeding, or when counts are 5 to 30 × 103 per μL (5 to 30 × 109 per L) and bleeding risk is substantial	A drop in platelet count of 30% or more is associated with an increase in intensive care unit–mortality	Thrombocytopenia has a higher prevalence of disseminated intravascular coagulopathy, bleeding, and transfusion requirement33
Corticosteroids		Consider in patients with septic shock not responsive to vasopressor therapy and fluid resuscitation*	Hydrocortisone did not significantly reduce mortality rates compared with placebo34	Surviving Sepsis Campaign guidelines downgraded the recommendation for corticosteroid use from strong to weak23
Deep venous thrombosis prophylaxis		Use low-dose unfractionated heparinor low-molecular-weight heparin unless contraindicated	Several trials in acutely ill patients demonstrate reduction of deep venous thrombosis and pulmonary embolus with prophylaxis23	Use mechanical devices when heparins are contraindicated; in very high-risk patients, low-molecular-weight heparin is preferred over unfractionated heparin
Glycemic control		Use intravenous insulin to maintain blood glucose level < 180 mg per dL (10 mmol per L), with a goal of approximately 150 mg per dL (8.3 mmol per L)	Intensive glycemic control (blood glucose targets level < 150 mg per dL) provides no benefit over conventional glycemic control35,36	Hyperglycemia can induce apoptosis, ischemia, and delayed healing; it should be avoided in all patients with sepsis because of potentially harmful effects and increased risk of death
Stress ulcer prophylaxis		For patients with thrombocytopenia or multiorgan failure, or who are receiving mechanical ventilation	Reduction of clinically significant upper gastrointestinal bleeding	No significant difference between proton pump inhibitors and histamine H2 receptor antagonist in gastrointestinal bleeding, pneumonia, or intensive care unit mortality37
Vasopressor therapy		Norepinephrine† and dopamine‡ are the preferred vasopressor agents for hypotension not responsive to fluid resuscitation	No significant difference in mortality rates between dopamine and norepinephrine vasopressor therapy 26	Use inotropic agents§ when hypotension is mainly from myocardial depression