Current concepts on hemodynamic support and therapy in septic shock

Abstract

Severe sepsis and septic shock represent a major healthcare challenge. Much of the improvement in mortality associated with septic shock is related to early recognition combined with timely fluid resuscitation and adequate antibiotics administration. The main goals of septic shock resuscitation include intravascular replenishment, maintenance of adequate perfusion pressure and oxygen delivery to tissues. To achieve those goals, fluid responsiveness evaluation and complementary interventions - i.e. vasopressors, inotropes and blood transfusion - may be necessary. This article is a literature review of the available evidence on the initial hemodynamic support of the septic shock patients presenting to the emergency room or to the intensive care unit and the main interventions available to reach those targets, focusing on fluid and vasopressor therapy, blood transfusion and inotrope administration.

Parallels in Sepsis and COVID-19 Conditions: Implications for Managing Severe COVID-19

“…Hypovolemia leading to hypotension, reduced venous return, low tissue perfusion and multiple organ dysfunction are associated with septic shock ( 56 , 57 ). Hence, fluid resuscitation, with the aim of restoring intravascular volume, adequate tissue perfusion and organ homeostasis is often undertaken in septic shock management, howbeit, with caution against pulmonary fluid overload ( 56 , 58 ). Fluid resuscitation could also be considered for the management of COVID-19, but following relevant guidelines regarding the type, volume and duration of the fluid ( 45 ).…”

Glucocorticoid resistance as a major drive in sepsis pathology

“…Sepsis can aggravate to severe sepsis, associated with organ failure, and septic shock, when patients become depended on vasopressors. In Western countries, sepsis patients are treated in Intensive Care Units with antibiotics, fluid resuscitation and support of organ functions [65]. Although sepsis research is confronted with numerous negative results and controversies, our knowledge on the basic pathological changes in sepsis is steadily advancing.…”

Basic Shock Physiology and Critical Care

“…Not only does inadequate DO 2 result from hypovolemia, pulmonary disease, and dyshemoglobinemia but it can also be caused by altered cellular function, as seen with sepsis and mitochondrial dysfunction in the critically ill. During such insults, the cell's machinery, cell membrane, protein receptors, and genes become dysfunctional, leading to apoptosis and loss of integrity. 21 Nonmammalian species such as reptiles and birds have different values for DO 2 , VO 2 , and O 2 ER because of slower or faster heart rates, hemoglobin concentration, and saturation of hemoglobin. Reptiles, depending on the species, balance oxygen delivery during exercise differently.…”