[Advances in the study of de-resuscitation in septic shock]

The initial management of septic shock necessitates adequate fluid resuscitation to restore tissue perfusion. However, excessive or sustained fluid administration may precipitate fluid accumulation syndrome (FAS), significantly exacerbating the risk of organ dysfunction and mortality. Consequently, proactive prevention and management of FAS are paramount for optimizing patient outcomes. With the continuous optimization of fluid resuscitation strategies in the treatment of septic shock, de-resuscitation, as a key stage for preventing or correcting FAS, provides an important opportunity to improve patient prognosis. Recent studies have shown that during the later phase of septic shock resuscitation, active de-resuscitation combined with hemodynamic monitoring, adjustment of vasoactive drugs and other comprehensive intervention measures can help reduce fluid positive balance, lower the risk of organ dysfunction, shorten the length of intensive care unit (ICU) stay, and improve patient prognosis. Currently, the timing of de-resuscitation, volume assessment methods, the development of individualized treatment protocols, and the prevention and control of related complications have become the focus of research, while the search for reliable biomarkers to guide de-resuscitation strategies will become a future hot direction. In this article, we review the pathophysiology and clinical diagnosis of FAS, as well as the clinical strategies, controversies and challenges of de-resuscitation in septic shock, and explore the future research directions of de-resuscitation strategies, with the aim of providing theoretical basis and practical guidance for optimizing fluid management in patients with septic shock.