Decoding the haemodynamics in sepsis to avoid drowning in salt water

When a patient is described as 'septic', a clinical cascade occurs to simultaneously attempt to diagnose, risk-stratify, and treat a patient with a presumed infection. Elements of this clinical cascade include laboratory investigations, medication administration, and often specialty service consultations. The clinical consequences of each of these interventions have largely been independently investigated, and their impacts have varied. The primary focus of the management of septic shock has traditionally revolved around resuscitative efforts intended to rapidly restore perfusion to the organs through the use of i.v. fluids, vasopressor, and inotropic support. Such strategies, if deployed carelessly, have the potential to lead to iatrogenic harms. Clinicians should consider the wide variety of haemodynamic phenotypes encountered when treating patients presenting in septic shock and tailor supporting measures to specific physiologic perturbations.