Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies
Sepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; however, there are aspects that have changed. This...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/14/2/176 |
| _version_ | 1797297739239784448 |
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| author | Fernando Ramasco Jesús Nieves-Alonso Esther García-Villabona Carmen Vallejo Eduardo Kattan Rosa Méndez |
| author_facet | Fernando Ramasco Jesús Nieves-Alonso Esther García-Villabona Carmen Vallejo Eduardo Kattan Rosa Méndez |
| author_sort | Fernando Ramasco |
| collection | DOAJ |
| description | Sepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; however, there are aspects that have changed. This narrative review highlights current and avant-garde methods of handling patients experiencing septic shock based on the experience of its authors and the best available evidence in a context of uncertainty. Following the first recommendation of the Surviving Sepsis Campaign guidelines, it is recommended that specific sepsis care performance improvement programs are implemented in hospitals, i.e., “Sepsis Code” programs, designed ad hoc, to achieve this goal. Regarding hemodynamics, the importance of perfusion and hemodynamic coherence stand out, which allow for the recognition of different phenotypes, determination of the ideal time for commencing vasopressor treatment, and the appropriate fluid therapy dosage. At present, this is not only important for the initial timing, but also for de-resuscitation, which involves the early weaning of support therapies, directed elimination of fluids, and fluid tolerance concept. Finally, regarding blood purification therapies, those aimed at eliminating endotoxins and cytokines are attractive in the early management of patients in septic shock. |
| first_indexed | 2024-03-07T22:24:43Z |
| format | Article |
| id | doaj.art-63532b99165e4a1192e7fc69ba34f718 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-07T22:24:43Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-63532b99165e4a1192e7fc69ba34f7182024-02-23T15:23:46ZengMDPI AGJournal of Personalized Medicine2075-44262024-02-0114217610.3390/jpm14020176Challenges in Septic Shock: From New Hemodynamics to Blood Purification TherapiesFernando Ramasco0Jesús Nieves-Alonso1Esther García-Villabona2Carmen Vallejo3Eduardo Kattan4Rosa Méndez5Department of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de León 62, 28006 Madrid, SpainDepartment of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de León 62, 28006 Madrid, SpainDepartment of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de León 62, 28006 Madrid, SpainDepartment of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de León 62, 28006 Madrid, SpainDepartamento de Medicina Intensiva del Adulto, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago 8320000, ChileDepartment of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de León 62, 28006 Madrid, SpainSepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; however, there are aspects that have changed. This narrative review highlights current and avant-garde methods of handling patients experiencing septic shock based on the experience of its authors and the best available evidence in a context of uncertainty. Following the first recommendation of the Surviving Sepsis Campaign guidelines, it is recommended that specific sepsis care performance improvement programs are implemented in hospitals, i.e., “Sepsis Code” programs, designed ad hoc, to achieve this goal. Regarding hemodynamics, the importance of perfusion and hemodynamic coherence stand out, which allow for the recognition of different phenotypes, determination of the ideal time for commencing vasopressor treatment, and the appropriate fluid therapy dosage. At present, this is not only important for the initial timing, but also for de-resuscitation, which involves the early weaning of support therapies, directed elimination of fluids, and fluid tolerance concept. Finally, regarding blood purification therapies, those aimed at eliminating endotoxins and cytokines are attractive in the early management of patients in septic shock.https://www.mdpi.com/2075-4426/14/2/176sepsisseptic shockhemodynamic coherencesepsis phenotypesadsorption therapiesendotoxin |
| spellingShingle | Fernando Ramasco Jesús Nieves-Alonso Esther García-Villabona Carmen Vallejo Eduardo Kattan Rosa Méndez Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies Journal of Personalized Medicine sepsis septic shock hemodynamic coherence sepsis phenotypes adsorption therapies endotoxin |
| title | Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies |
| title_full | Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies |
| title_fullStr | Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies |
| title_full_unstemmed | Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies |
| title_short | Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies |
| title_sort | challenges in septic shock from new hemodynamics to blood purification therapies |
| topic | sepsis septic shock hemodynamic coherence sepsis phenotypes adsorption therapies endotoxin |
| url | https://www.mdpi.com/2075-4426/14/2/176 |
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