Adjunctive Therapies

Enteral nutrition is recommended in septic patients to meet the increased energy and protein requirements. Protein requirements are increased to 1.5 to 2.5 g/kg/day. Non-

protein caloric requirements range from 25 to 40 kcal/kg/day (105-168 kJ/kg/day).

DVT prophylaxis is recommended for septic patients. Low-dose unfractionated heparin or low-molecular-weight heparin (such as enoxaparin or dalteparin) may be utilized. Graduated compression stockings or an intermittent compression device is recommended for patients with a contraindication to heparin products (thrombocyt-

openia, severe coagulopathy, active bleeding, or recent intracerebral hemorrhage). Patients with severe sepsis and history of DVT, trauma, or orthopedic surgery should receive a combination of pharmacologic and mechanical therapy unless contraindic-ated or not practical.

Stress ulcer prophylaxis is recommended in septic patients. Patients at greatest risk for stress ulcers are: coagulopathic, mechanically ventilated, and hypotensive. Histamine-receptor antagonists (such as ranitidine) are more efficacious than sucral-fate, and proton pump inhibitors (such as omeprazole) have not been compared to histamine-receptor antagonists. However, they do demonstrate equivalence in the

ability to increase gastric pH. The benefit of prophylaxis must be weighed against the potential effect of an increased stomach pH and development of hospital-acquired pneumonia.

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