Resuscitation Targets, Fluids, and Vasoactives in Septic Shock

Intravenous fluids and vasoactive medications represent the foundation of hemodynamic resuscitation for septic shock. Based on current evidence, initial fluid resuscitation of roughly 30 mL/kg with balanced crystalloids is reasonable for most patients. Carefully monitored peripheral vein administration of the first-line vasopressor, norepinephrine, appears safe. Ongoing multimodal assessment and therapy titration integrating blood pressure, lactate clearance, capillary refill time, and dynamic measures of fluid responsiveness yields outcomes equivalent to protocolized goal-directed resuscitation. However, better evidence is urgently needed for many common septic shock management issues.