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Current practice and evolving concepts in septic shock resuscitation

  • Narrative Review
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Clinical and pathophysiological understanding of septic shock has progressed exponentially in the previous decades, translating into a steady decrease in septic shock-related morbidity and mortality. Even though large randomized, controlled trials have addressed fundamental aspects of septic shock resuscitation, many questions still exist. In this review, we will describe the current standards of septic shock resuscitation, but the emphasis will be placed on evolving concepts in different domains such as clinical resuscitation targets, adequate use of fluids and vasoactive drugs, refractory shock, and the use of extracorporeal therapies. Multiple research opportunities remain open, and collaborative endeavors should be performed to fill in these gaps.

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Abbreviations

RCT:

Randomized controlled trials

SSC:

Surviving Sepsis Campaign

CO:

Cardiac output

PLR:

Passive leg raising test

SVV:

Stroke volume variation

PPV:

Pulse pressure variation

MAP:

Mean arterial pressure

LV:

Left ventricular

CRT:

Capillary refill time

ICU:

Intensive care unit

tRBCp:

Tissue red blood cell perfusion

SOSD:

Salvage, optimization, stabilization, de-escalation

DAP:

Diastolic arterial pressure

ScvO2 :

Central venous oxygenation

MV:

Mechanical ventilation

VAC:

Ventriculo-arterial coupling

Ea:

Arterial elastance

Ees:

End-systolic elastance

Eadyn :

Dynamic arterial elastance

ATII:

Angiotensin II

MB:

Methylene blue

LVEF:

Left ventricular ejection fraction

VTI:

Aortic velocity time integral

ECBPT:

Extracorporeal blood purification techniques

VA-ECMO:

Venous–arterial extracorporeal membrane oxygenation

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Authors and Affiliations

  1. Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    Jan Bakker & Can Ince

  2. Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA

    Jan Bakker

  3. NYU School of Medicinel Langone, New York, USA

    Jan Bakker

  4. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

    Jan Bakker, Eduardo Kattan, Ricardo Castro & Glenn Hernandez

  5. Intensive Care Unit-AP-HP, Hôpital Raymond-Poincaré, Garches, France

    Djillali Annane

  6. UFR des Sciences de la Santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France

    Djillali Annane

  7. Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy

    Maurizio Cecconi

  8. Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

    Maurizio Cecconi

  9. Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium

    Daniel De Backer

  10. Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina

    Arnaldo Dubin

  11. Sanatorio Otamendi, Buenos Aires, Argentina

    Arnaldo Dubin

  12. Department of Pulmonary and Critical Care Medicine, University of Washington, Seattle, USA

    Laura Evans

  13. Division of Critical Care Medicine, Division of Pulmonary Medicine, Department of Medicine, Montefiore Healthcare System/Albert Einstein College of Medicine, Bronx, NY, USA

    Michelle Ng Gong

  14. Service de Réanimation Polyvalente, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 92141, Clamart, France

    Olfa Hamzaoui

  15. Service de Réanimation Médicale Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France

    Bruno Levy

  16. INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, France

    Bruno Levy

  17. Université de Lorraine, Nancy, France

    Bruno Levy

  18. Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France

    Xavier Monnet

  19. Department of Intensive Care Medicine Fundación Valle del Lili, Universidad ICESI, Cali, Colombia

    Gustavo A. Ospina Tascón

  20. Department of Critical Care, King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Marlies Ostermann

  21. Department Bioengineering, Anesthesiology and Cardiovascular Diseases, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA

    Michael R. Pinsky

  22. Centre for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada

    James A. Russell

  23. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Bernd Saugel

  24. Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Thomas W. L. Scheeren

  25. Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, AP-HP Université Paris-Saclay, Inserm UMR S_999, Le Kremlin-Bicêtre, France

    Jean-Louis Teboul

  26. Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France

    Antoine Vieillard Baron

  27. INSERM UMR 1018, Clinical Epidemiology Team, CESP, Paris-Saclay University, Villejuif, France

    Antoine Vieillard Baron

  28. Dept of Intensive Care, Erasme Univ Hospital, Université Libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

  29. HCor Research Institute, São Paulo, Brazil

    Fernando G. Zampieri

  30. D’Or Research and Education Institute, São Paulo, Brazil

    Fernando G. Zampieri

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  1. Jan Bakker
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  2. Eduardo Kattan
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  3. Djillali Annane
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  6. Daniel De Backer
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  24. Glenn Hernandez
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Contributions

GH, JB, EK and DDB conceived the manuscript; DA, JB, RC, MC, DDB, AD, LE, MNG, OH, GH, EK, CI, BL, XM, GOT, MO, MP, JR, BS, TWLS, JLT, AVB, JLV, FGZ drafted specific parts of the manuscript, critically revised and approved its final contents.

Corresponding author

Correspondence to Glenn Hernandez.

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Conflicts of interest

DA, JB, RC, DDB, AD, LE, MNG, OH, GH, EK, BL, XM, GOT, MO, MP, JR, TWLS, JLT, AVB, JLV, FGZ declare no conflicts of interest. BS is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences Inc. (Irvine, CA, USA). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Pulsion Medical Systems SE (Feldkirchen, Germany). BS has received institutional restricted research grants and honoraria for giving lectures from CNSystems Medizintechnik GmbH (Graz, Austria). BS is a consultant for and has received honoraria for giving lectures from Philips Medizin Systeme Böblingen GmbH (Böblingen, Germany). BS is a consultant for and has received honoraria for giving lectures from GE Healthcare (Chicago, IL, USA). BS is a consultant for Vygon (Aachen, Germany). BS is a consultant for and has received institutional restricted research grants from Retia Medical LLC. (Valhalla, NY, USA). BS was a consultant for and has received institutional restricted research grants from Tensys Medical Inc. (San Diego, CA, USA); FGZ has received grants for investigator-initiated trials from Bactiguard, Sweden, and Ionis Pharmaceuticals, USA, unrelated to the scope of this work. FGZ was the principal investigator of the BaSICS trial, which received logistics support from Baxter Hospitalar, Brazil; CI received educational grants from LaJolla Pharmaceuticals (LaJolla, Cal USA) and educational grants and speaker fees from Cytosorbents Europe (Berlin Germany). CI is Chief Scientific Officer and holds shares in Active Medical BV (Leiden, The Netherlands), a company that provides educational services, products and software related to clinical microcirculation using sublingual hand-held vital microscopes; AVB received a research grant from GSK. AVB received Fees from Air Liquide for being in an advisory board for conducting a clinical research; BL received grants from Novartis, Abiomed, Amomed, orion, Gettinge; MC performed consultancies for Edwards Lifesciences and Directed Systems;

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Bakker, J., Kattan, E., Annane, D. et al. Current practice and evolving concepts in septic shock resuscitation. Intensive Care Med 48, 148–163 (2022). https://doi.org/10.1007/s00134-021-06595-9

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