New Progress of Goal-Directed Fluid Resuscitation for Septic Shock
Fluid resuscitation is the cornerstone of resuscitation in patients with septic shock. In 2001, Rivers presented the early goal-directed therapy (EGDT) strategies to direct intravenous infusion for septic shock patients. As a result, EGDT was adopted by the Surviving Sepsis Campaign. Recently a trio of trials (ProCESS, ARISE, and ProMISe) question the continued need for all of the elements of EGDT or the need for protocolized care for patients with septic shock. Nevertheless, it is important to find the right goal for septic shock to direct fluid resuscitation. However, it must be recognized that due to the pathophysiological characteristics of septic shock, the goals of resuscitation at different stages of shock are different. Therefore, in the continuous process of the development of septic shock, we must fully understand the meaning and limitations of various parameters, so as to select the right goal to direct the fluid resuscitation therapy. In this chapter, we will introduce all kinds of parameters used to guide fluid resuscitation for septic shock patients. And some new parameters including metabolic parameters and dynamic parameters will be highlighted in this chapter.
KeywordsFluid resuscitation Septic shock Goal-directed fluid resuscitation (EGDT) Fluid challenge Lactate (LAC) and lactate clearance Stroke volume variation (SVV) Pulse pressure variation (PPV) End-expiratory occlusion test (EEOt) Superior/inferior vena cava collapsibility index (SVC-CIIVC-CI) Tidal volume challenge
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