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Case Scenario for Fluid Therapy in Septic Shock

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Perioperative Fluid Management

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Abstract

Septic shock represents a profound systemic inflammatory derangement with components of functional hypovolemia, altered oxygen delivery, myocardial dysfunction, peripheral vasoplegia, and diffuse capillary leak. In this case scenario, a patient exhibits all of the aforementioned findings with lactic acidosis, elevated troponin, persistent hypotension despite vasopressor use, acute kidney injury, and acute lung injury due to septic shock. In addition to source control and early antibiotic administration, the goals of treatment are early and aggressive fluid resuscitation, maintenance of tissue perfusion, and judicious and balanced application of vasopressor support. As excess fluid balance is associated with worse outcomes, it is the job of the clinician to evaluate the patient’s response to fluid therapy with one of several tools. After adequate fluid resuscitation has been achieved, additional support may be required with vasopressors. As the patient’s clinical course improves the physician should aim to gently ‘de-resuscitate’ excess fluid.

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Authors and Affiliations

  1. Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Ashish K. Khanna

  2. Outcomes Research Consortium, Cleveland, OH, USA

    Ashish K. Khanna

  3. Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Michael D. Font

  4. Department of General Anesthesiology, Quality Improvement Officer, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

    Piyush Mathur

Authors
  1. Ashish K. Khanna
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  2. Michael D. Font
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  3. Piyush Mathur
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Correspondence to Ashish K. Khanna .

Editor information

Editors and Affiliations

  1. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Ehab Farag

  2. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Andrea Kurz

  3. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Christopher Troianos

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Khanna, A.K., Font, M.D., Mathur, P. (2020). Case Scenario for Fluid Therapy in Septic Shock. In: Farag, E., Kurz, A., Troianos, C. (eds) Perioperative Fluid Management. Springer, Cham. https://doi.org/10.1007/978-3-030-48374-6_22

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