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Individualized fluid optimization and de-escalation in critically ill patients with septic shock
Antonio Messina1,2, Guia Margherita Matronola3, Maurizio Cecconi1,2
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele.
Current Opinion in Critical Care
|August 5, 2025
Summary
Individualized fluid management for septic shock is crucial. Fluid stewardship, tailored to patient needs across four phases, improves outcomes and reduces fluid overload complications.
Area of Science:
- Critical Care Medicine
- Intensive Care
- Fluid Therapy
Background:
- Septic shock management requires precise fluid administration.
- Traditional fluid protocols often lead to suboptimal outcomes or fluid overload.
- Evolving evidence supports personalized fluid strategies.
Purpose of the Study:
- To offer a current overview of individualized fluid management in septic shock.
- To integrate recent evidence on fluid responsiveness and stewardship.
- To guide practical application of tailored fluid strategies.
Main Methods:
- Review of recent clinical trials (e.g., ANDROMEDA, CLASSIC).
- Analysis of emerging evidence on dynamic fluid responsiveness assessment.
- Integration of fluid stewardship principles across clinical phases.
Main Results:
- Dynamic, patient-tailored fluid strategies are superior to standardized protocols.
- Fluid responsiveness assessment, restricted fluids, and early vasopressors are key.
- Fluid stewardship (resuscitation, optimization, stabilization, de-escalation) aids outcomes.
- Balanced crystalloids and individualized targets are recommended.
Conclusions:
- Septic shock fluid therapy is shifting towards individualized, phase-based management.
- Hemodynamic monitoring and dynamic reassessment personalize fluid administration.
- Personalized fluid stewardship enhances recovery and minimizes fluid overload complications.
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