Evolving Management Practices for Early Sepsis-induced Hypoperfusion: A Narrative Review

Area of Science:

• Critical Care Medicine
• Emergency Medicine
• Internal Medicine

Background:

• Sepsis remains a leading cause of global morbidity and mortality.
• Effective resuscitation is critical for managing sepsis-induced hypoperfusion.
• Evolving practices aim to optimize early sepsis management.

Approach:

• Review of seminal evidence on fluid resuscitation volume and vasopressor timing.
• Discussion of evolving practices in resuscitation targets and administration routes.
• Analysis of invasive versus non-invasive blood pressure monitoring in sepsis.

Key Points:

• Fluid-restrictive strategies paired with earlier vasopressor initiation are under investigation.
• Lower mean arterial pressure targets (60-65 mm Hg) appear safe, particularly in older adults.
• Peripheral vasopressor administration and less invasive blood pressure monitoring are increasingly considered.

Conclusions:

• Sepsis resuscitation is trending towards fluid-sparing and less invasive approaches.
• Further research is needed to refine optimal strategies for early sepsis-induced hypoperfusion.
• Optimizing resuscitation remains crucial for improving sepsis outcomes.