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

Sepsis is a dysregulated, potentially fatal host response to infection, characterized by heterogeneity in clinical presentation and organ failure mechanisms. Early hemodynamic resuscitation and antibiotics are crucial treatments. Current guidelines recommend a one-size-fits-all approach of 30 mL/kg fluids, which may worsen vascular leakage and organ dysfunction in some patients. Personalized strategies using biomarkers and dynamic fluid responsiveness assessments offer a more tailored approach, potentially preventing fluid overload while ensuring perfusion. A recent multiomics analysis identified sepsis subgroups benefiting from either liberal or restrictive fluid resuscitation, highlighting -omics' potential in personalized fluid management and the role of immune regulation and endothelial dysfunction in septic shock. Despite progress, methodological challenges hinder clinical implementation of biomarkers. Addressing issues like rapid point-of-care biomarker assays already at emergency department or ICU admission, standardizing sepsis diagnosis, robust external validation, and clinical trial enrichment is crucial for advancing biomarker-guided fluid management in clinical settings.