Hemodynamic Support in Sepsis

Sepsis is a dysregulated host response to infection responsible for life-threatening organ dysfunction.¹  Along with early antimicrobial administration and source control, correction of hemodynamic derangements is a crucial aspect of sepsis management. In this review, we will discuss the recent evidence in managing sepsis-induced hemodynamic alterations and how it can be integrated with previous knowledge for actionable interventions in adult patients. Fluid underresuscitation is associated with a risk of poor organ perfusion and excessive vasopressors use, while overresuscitation is associated with a risk of fluid overload and organ congestion (i.e., pulmonary edema, abdominal compartment syndrome, acute kidney injury [AKI], liver injury). In this review, we will especially discuss the strategies for initial fluid resuscitation and vasopressors administration, the choice of fluid, and hemodynamic targets to guide resuscitation in adults.

The 2021 surviving sepsis campaign guidelines recommend 30 ml/kg crystalloids during the first 3 h of sepsis based...