Management of Sepsis: Early Resuscitation

Unintended Consequences: Fluid Resuscitation Worsens Shock in an Ovine Model of Endotoxemia

“…It is thought that adequate fluid resuscitation in the early phase of sepsis improves shock and results in reduced vasopressor requirements later in a patients illness 7 . The key finding of this study was that fluid resuscitation given for endotoxemic shock produced short-lived haemodynamic improvements which were then followed by significantly increased vasopressors requirements in the subsequent 12 hours.…”

“…One of the main aims of fluid resuscitation in sepsis is the reversal of pathologic tissue hypoperfusion preventing the onset of tissue ischemia and organ dysfunction 6,7 . We aimed to use tissue microdialysis to detect potentially favourable effects of fluid resuscitation on the microcirculation of the various vital organs.…”

“…To this end FR is employed to increase cardiac output to reverse pathological hypoperfusion, preventing organ injury 4,7 . Whilst there has been widespread adoption there is emerging evidence that calls into question both the safety and efficacy of fluid resuscitation [8][9][10] .…”

Applied Physiology and the Hemodynamic Management of Septic Shock Utilizing the Physiologic Optimization Program

“…(McGee & Jodka. 2002;Kumar, 2009, Teule 1984 Septic patients also have extravasation of fluid into the interstitium related to increased permeability of the capillary endothelium (Rivers 2008;Pieracci 2011). These phenomena result in decreased preload, cardiac output and inadequate oxygen delivery.…”

Metabolomics in Sepsis and Its Impact on Public Health

“…Sepsis and its more severe forms, such as septic shock, may lead to organ dysfunction, organ failure, and death [4]. Although its mortality has decreased over the last years, mainly due to the application of bundled early goal-directed therapy [5], sepsis, with its often devastating consequences for patients and their families, remains a major public health concern that poses an increasing financial burden. Indicatively, a mean intensive care unit (ICU) cost per patient of more than USD 27,000 and an average length of stay in the ICU and the hospital often extending beyond 5 and 20 days, respectively, illustrate the burden imposed on the patients, their families, and national health care systems worldwide as well as the need for early diagnosis and personalized treatment of sepsis [6-8].…”