Why Has Biomarker-Guided Fluid Resuscitation for Sepsis Not Been Implemented in Clinical Practice?

Area of Science:

• Critical Care Medicine
• Translational Medicine
• Genomics and Proteomics

Background:

• Sepsis is a life-threatening infection response with varied patient presentations and organ damage.
• Current sepsis fluid resuscitation guidelines (30 mL/kg) may harm some patients by increasing vascular leakage.
• Personalized fluid management using biomarkers and dynamic assessments is needed to optimize perfusion and prevent fluid overload.

Purpose of the Study:

• To explore the potential of multiomics analysis in identifying sepsis subgroups for tailored fluid resuscitation strategies.
• To investigate the role of immune regulation and endothelial dysfunction in septic shock.
• To highlight the challenges and future directions for implementing biomarker-guided fluid management in clinical practice.

Main Methods:

• Utilized multiomics analysis to identify distinct sepsis patient subgroups.
• Examined immune regulation and endothelial dysfunction markers.
• Reviewed current fluid resuscitation guidelines and their limitations.

Main Results:

• Identified specific sepsis subgroups that benefit from either liberal or restrictive fluid resuscitation.
• Highlighted the potential of multiomics in personalizing fluid management for septic shock.
• Confirmed the involvement of immune dysregulation and endothelial dysfunction in septic shock heterogeneity.

Conclusions:

• Multiomics analysis can stratify sepsis patients for personalized fluid resuscitation, moving beyond a one-size-fits-all approach.
• Tailored fluid strategies informed by biomarkers and -omics data hold promise for improving septic shock management.
• Overcoming methodological challenges in biomarker development and validation is critical for clinical translation.