Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines
Although the Surviving Sepsis Campaign guidelines provide standardized and generalized guidance, they are less individualized. This review focuses on recent updates in the hemodynamic management of septic shock. Monitoring and intervention for septic shock should be personalized according to the pha...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
The Korean Society of Emergency Medicine
2023-09-01
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| Series: | Clinical and Experimental Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.ceemjournal.org/upload/pdf/ceem-23-065.pdf |
| _version_ | 1797659670303735808 |
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| author | Gil Joon Suh Tae Gun shin Woon Yong Kwon Kyuseok Kim You Hwan Jo Sung-Hyuk Choi Sung Phil Chung Won Young Kim |
| author_facet | Gil Joon Suh Tae Gun shin Woon Yong Kwon Kyuseok Kim You Hwan Jo Sung-Hyuk Choi Sung Phil Chung Won Young Kim |
| author_sort | Gil Joon Suh |
| collection | DOAJ |
| description | Although the Surviving Sepsis Campaign guidelines provide standardized and generalized guidance, they are less individualized. This review focuses on recent updates in the hemodynamic management of septic shock. Monitoring and intervention for septic shock should be personalized according to the phase of shock. In the salvage phase, fluid resuscitation and vasopressors should be given to provide life-saving tissue perfusion. During the optimization phase, tissue perfusion should be optimized. In the stabilization and de-escalation phases, minimal fluid infusion and safe fluid removal should be performed, respectively, while preserving organ perfusion. There is controversy surrounding the use of restrictive versus liberal fluid strategies after initial resuscitation. Fluid administration after initial resuscitation should depend upon the patient’s fluid responsiveness and requires individualized management. A number of dynamic tests have been proposed to monitor fluid responsiveness, which can help clinicians decide whether to give fluid or not. The optimal timing for the initiation of vasopressor agents is unknown. Recent data suggest that early vasopressor initiation should be considered. Inotropes can be considered in patients with decreased cardiac contractility associated with impaired tissue perfusion despite adequate volume status and arterial blood pressure. Venoarterial extracorporeal membrane oxygenation should be considered for refractory septic shock with severe cardiac systolic dysfunction. |
| first_indexed | 2024-03-11T18:18:33Z |
| format | Article |
| id | doaj.art-cfdb2d2475f247518a1673ed7afb15f3 |
| institution | Directory Open Access Journal |
| issn | 2383-4625 |
| language | English |
| last_indexed | 2024-03-11T18:18:33Z |
| publishDate | 2023-09-01 |
| publisher | The Korean Society of Emergency Medicine |
| record_format | Article |
| series | Clinical and Experimental Emergency Medicine |
| spelling | doaj.art-cfdb2d2475f247518a1673ed7afb15f32023-10-16T05:21:15ZengThe Korean Society of Emergency MedicineClinical and Experimental Emergency Medicine2383-46252023-09-0110325526410.15441/ceem.23.065481Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelinesGil Joon Suh0Tae Gun shin1Woon Yong Kwon2Kyuseok Kim3You Hwan Jo4Sung-Hyuk Choi5Sung Phil Chung6Won Young Kim7 Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Korea Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaAlthough the Surviving Sepsis Campaign guidelines provide standardized and generalized guidance, they are less individualized. This review focuses on recent updates in the hemodynamic management of septic shock. Monitoring and intervention for septic shock should be personalized according to the phase of shock. In the salvage phase, fluid resuscitation and vasopressors should be given to provide life-saving tissue perfusion. During the optimization phase, tissue perfusion should be optimized. In the stabilization and de-escalation phases, minimal fluid infusion and safe fluid removal should be performed, respectively, while preserving organ perfusion. There is controversy surrounding the use of restrictive versus liberal fluid strategies after initial resuscitation. Fluid administration after initial resuscitation should depend upon the patient’s fluid responsiveness and requires individualized management. A number of dynamic tests have been proposed to monitor fluid responsiveness, which can help clinicians decide whether to give fluid or not. The optimal timing for the initiation of vasopressor agents is unknown. Recent data suggest that early vasopressor initiation should be considered. Inotropes can be considered in patients with decreased cardiac contractility associated with impaired tissue perfusion despite adequate volume status and arterial blood pressure. Venoarterial extracorporeal membrane oxygenation should be considered for refractory septic shock with severe cardiac systolic dysfunction.http://www.ceemjournal.org/upload/pdf/ceem-23-065.pdfseptic shockresuscitationfluid responsivenessvasopressor agentextracorporeal membrane oxygenation |
| spellingShingle | Gil Joon Suh Tae Gun shin Woon Yong Kwon Kyuseok Kim You Hwan Jo Sung-Hyuk Choi Sung Phil Chung Won Young Kim Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines Clinical and Experimental Emergency Medicine septic shock resuscitation fluid responsiveness vasopressor agent extracorporeal membrane oxygenation |
| title | Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines |
| title_full | Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines |
| title_fullStr | Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines |
| title_full_unstemmed | Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines |
| title_short | Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines |
| title_sort | hemodynamic management of septic shock beyond the surviving sepsis campaign guidelines |
| topic | septic shock resuscitation fluid responsiveness vasopressor agent extracorporeal membrane oxygenation |
| url | http://www.ceemjournal.org/upload/pdf/ceem-23-065.pdf |
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