[Myth "Volume Deficiency in Sepsis"]

Area of Science:

• Critical Care Medicine
• Cardiology
• Infectious Diseases

Background:

• Septic shock is a life-threatening condition characterized by immune dysregulation, leading to organ damage and death.
• Effective management hinges on early recognition and addressing tissue perfusion loss.
• Traditional fluid therapy in the initial phase is being re-evaluated due to risks of fluid overload and increased mortality.

Purpose of the Study:

• To introduce a framework of five distinct hemodynamic phenotypes in septic shock.
• To guide individualized fluid and vasopressor therapy based on these phenotypes.
• To enhance patient outcomes through precision medicine in septic shock management.

Main Methods:

• Utilized echocardiographic and clinical parameters to identify hemodynamic phenotypes.
• Employed passive leg raise (PLR) testing and echocardiographic monitoring for fluid responsiveness assessment.
• Incorporated early norepinephrine administration to improve fluid efficiency.

Main Results:

• Identified five phenotypes: Well resuscitated, Left ventricular systolic dysfunction, Hyperkinetic state, Right ventricular failure, and Still hypovolemic.
• Phenotype 2 requires inotropes, Phenotype 3 and 4 are not fluid-responsive, Phenotype 5 benefits from fluids.
• Phenotyping provides a basis for precision fluid and vasopressor management.

Conclusions:

• Hemodynamic phenotyping enables a patient-specific approach to septic shock management.
• Balancing resuscitation needs with fluid overload risks optimizes survival.
• Personalized treatment strategies guided by these phenotypes are essential for improving septic shock outcomes.