Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

sepsis of unknown cause

1st line – admission to intensive care unit (ICU), empiric antimicrobial therapy, and supportive therapy

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INITIAL
|
sepsis of unknown cause
1st line – 

admission to intensive care unit (ICU), empiric antimicrobial therapy, and supportive therapy

Hantavirus cardiopulmonary syndrome (HCPS) can progress rapidly to cardiogenic shock and death and must be managed in an ICU.[47][60]​​[69]​​​

Empiric antimicrobial therapy for sepsis is appropriate until the diagnosis of HCPS is made. Local protocols and guidelines should be followed. Once the diagnosis is made, antibiotics should be discontinued. See Sepsis in adults and Sepsis in children.

Analgesia and antipyretics may be given while awaiting confirmation of diagnosis.

ACUTE

confirmed hantavirus infection

1st line – intensive supportive care

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ACUTE
|
confirmed hantavirus infection
1st line – 

intensive supportive care

Hantavirus cardiopulmonary syndrome (HCPS) can progress rapidly to cardiogenic shock and death and must be managed in an ICU.[47][60]​​[69]

If empiric antibiotics were started, they may be discontinued once a diagnosis of hantavirus infection is made.

Supplemental oxygen and intubation and mechanical ventilation for respiratory support may be required.[69]​ About 40% of patients admitted to the hospital will not require intubation and can be managed with supplemental oxygen and careful fluid administration.[10] Intubated survivors can usually be extubated within 1 week.[10]

Fluids should be given cautiously so as not to accelerate the development of pulmonary edema.[69]

Vasoactive agents may be required for cardiogenic shock. Dobutamine plus norepinephrine (noradrenaline) has been suggested as an effective regimen.[58][69]​ Dose should be started low and titrated according to response. Consult your local protocols for guidance on choice of regimen and dose.

Platelet transfusion may be required according to local protocols.[69]

Consider – extracorporeal membrane oxygenation (ECMO)

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ACUTE
|
confirmed hantavirus infection
Consider – 

extracorporeal membrane oxygenation (ECMO)

Treatment recommended for SOME patients in selected patient group

Early consideration of transfer to a center with ECMO access is key. A falling cardiac index with evidence of cardiovascular collapse is an indication for ECMO support.[58]

Studies suggest that up to 72% of hantavirus cardiopulmonary syndrome (HCPS) patients with high mortality risk supported with ECMO have survived to hospital discharge.[58][78]

Features indicating high mortality risk include: a cardiac index <2.5 L/minute/m²; serum lactate >4 mmol/L; cardiac arrhythmia (ventricular fibrillation, tachycardia, or pulseless electrical dissociation); shock refractory to fluids; and vasoactive therapy.[68]

Consider – experimental therapies

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ACUTE
|
confirmed hantavirus infection
Consider – 

experimental therapies

Treatment recommended for SOME patients in selected patient group

Experimental therapies may be used off-label during outbreaks. Consult your local public health authority for further guidance.

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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