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Published on: May 21, 2019
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Hemodynamic support in septic shock
Marina García-de-Acilu1, Jaume Mesquida2, Guillem Gruartmoner2
1Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona.
Current Opinion in Anaesthesiology
|March 2, 2021
Summary
Personalized hemodynamic resuscitation for septic shock is crucial, guiding fluid administration with tissue oxygenation markers and fluid responsiveness indices. Aggressive fluid strategies are discouraged, favoring tailored approaches with vasopressors and inotropes when needed.
Area of Science:
- Critical Care Medicine
- Cardiology
- Nephrology
Background:
- Septic shock management requires precise hemodynamic monitoring and support.
- Restoring tissue oxygenation is the primary goal of resuscitation.
Purpose of the Study:
- To review recent findings on monitoring and hemodynamic support in septic shock.
- To guide clinicians on optimal fluid resuscitation and vasopressor use.
Main Methods:
- Review of recent clinical trials and data on hemodynamic resuscitation.
- Analysis of multimodal approaches combining global and regional markers.
- Evaluation of dynamic indices for fluid responsiveness prediction.
Main Results:
- Evidence suggests against aggressive fluid resuscitation; personalized fluid administration based on fluid responsiveness is recommended.
- Balanced crystalloids may reduce renal failure compared to other fluids.
- Multimodal vasopressor use and dobutamine for systolic dysfunction are initial approaches; ECMO is an option for refractory cases.
Conclusions:
- Personalized resuscitation guided by tissue hypoxia markers and fluid responsiveness is essential.
- The efficacy of multimodal vasopressor strategies requires further investigation.
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