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Related Concept Videos

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Cardiopulmonary Resuscitation IV: Pharmacological Management

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Barriers to Effective Communication II

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Related Experiment Video

Updated: Jun 27, 2026

Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression
07:30

Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression

Published on: June 15, 2019

The Implementation Gap in Early Septic Shock Resuscitation: A Three-Barrier Framework.

Sajid Kadir1, Travis Murphy2, Joseph Shiber3

  • 1Divisions of Cardiovascular Medicine and Pulmonary and Critical Care Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.

Journal of Clinical Medicine
|June 26, 2026
PubMed
Summary

Early vasopressor administration for septic shock is evidence-based but delivery is limited by structural barriers. Improving patient outcomes requires addressing regulatory, cultural, and upstream delays in recognition and treatment.

Keywords:
SEP-1emergency departmentimplementationnorepinephrinequality measuresseptic shockvasopressors

Related Experiment Videos

Last Updated: Jun 27, 2026

Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression
07:30

Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression

Published on: June 15, 2019

Area of Science:

  • Emergency Medicine
  • Critical Care Medicine
  • Health Systems Science

Background:

  • The physiological rationale for early vasopressor use in septic shock is well-established through extensive research.
  • Despite strong evidence, timely administration of norepinephrine within the first hour of recognition remains inconsistent in many healthcare settings.

Purpose of the Study:

  • To reframe the challenge of early vasopressor delivery in septic shock from a clinical evidence issue to an implementation science problem.
  • To identify and analyze key structural barriers hindering timely vasopressor administration.

Main Methods:

  • Review of existing literature and analysis of implementation barriers.
  • Identification of three primary structural barriers: regulatory (SEP-1 measure), cultural (workflow and practice scope), and upstream (time to recognition).
  • Proposal of a parallel resuscitation framework with protocolized triggers.

Main Results:

  • The SEP-1 quality measure inadvertently incentivizes a fluids-first approach, despite physician exceptions.
  • A significant gap exists between policies allowing peripheral vasopressor use and the necessary operational infrastructure for bedside administration.
  • Delays in vasopressor initiation are often downstream from delays in initial patient recognition.

Conclusions:

  • Addressing early vasopressor delivery requires moving beyond physiological arguments to focus on operational and implementation challenges.
  • Rebuilding the healthcare system's operational architecture, including protocolized triggers and stratified implementation strategies, is crucial for improving septic shock resuscitation.