<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Septic shock is a common condition associated with hypotension and organ dysfunction. It is associated with high mortality rates of up to 60% despite the best recommended resuscitation strategies in international guidelines. Patients with septic shock generally have a Mean Arterial Pressure below 65 mmHg and hypotension is the most important determinant of mortality among this group of patients. The extent and duration of hypotension are important. The two initial options that we have are 1) administration of intravenous (IV) fluids and 2) vasopressors, The current recommendation of the Surviving Sepsis Campaign guidelines to administer 30 ml/kg fluid cannot be applied to all patients. Complications of fluid over-resuscitation further delay organ recovery, prolong ICU and hospital length of stay, and increase mortality. The only reason for administering intravenous fluids in a patient with circulatory shock is to increase the mean systemic filling pressure in a patient who is volume-responsive, such that cardiac output also increases. The use of vasopressors seems to be a more appropriate strategy, the very early administration of vasopressors, preferably during the first hour after diagnosis of septic shock, may have a multimodal action and potential advantages, leading to lower morbidity and mortality in the management of septic patients. Vasopressor therapy should be initiated as soon as possible in patients with septic shock.</p>
</abstract>

Septic shock is a common condition associated with hypotension and organ dysfunction. It is associated with high mortality rates of up to 60% despite the best recommended resuscitation strategies in international guidelines. Patients with septic shock generally have a Mean Arterial Pressure below 65 mmHg and hypotension is the most important determinant of mortality among this group of patients. The extent and duration of hypotension are important. The two initial options that we have are 1) administration of intravenous (IV) fluids and 2) vasopressors, The current recommendation of the Surviving Sepsis Campaign guidelines to administer 30 ml/kg fluid cannot be applied to all patients. Complications of fluid over-resuscitation further delay organ recovery, prolong ICU and hospital length of stay, and increase mortality. The only reason for administering intravenous fluids in a patient with circulatory shock is to increase the mean systemic filling pressure in a patient who is volume-responsive, such that cardiac output also increases. The use of vasopressors seems to be a more appropriate strategy, the very early administration of vasopressors, preferably during the first hour after diagnosis of septic shock, may have a multimodal action and potential advantages, leading to lower morbidity and mortality in the management of septic patients. Vasopressor therapy should be initiated as soon as possible in patients with septic shock.

Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet?

University of Pittsburgh School of Medicine

India Department of Critical Care Medicine

Department of Critical Care Medicine, accident and emergency

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution 4.0 International License.

Septic shock is a common condition associated with hypotension and organ dysfunction. It is associated with high mortality rates of up to 60% despite the best...

Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet?

Article Category: Review

Published Online: Jul 31, 2023

Page range: 138 - 147

Received: Jun 12, 2023

Accepted: Jul 22, 2023

DOI: https://doi.org/10.2478/jccm-2023-0022

Keywords
septic shock, sepsis, vasopressor, fluid, early norepinephrine

© 2023 E. Carlos Sanchez et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet?

Article Category: Review

Published Online: Jul 31, 2023

Page range: 138 - 147

Received: Jun 12, 2023

Accepted: Jul 22, 2023

DOI: https://doi.org/10.2478/jccm-2023-0022

Keywordsseptic shock, sepsis, vasopressor, fluid, early norepinephrine

© 2023 E. Carlos Sanchez et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Keywords
septic shock, sepsis, vasopressor, fluid, early norepinephrine