Septic Shock and Hemodynamic Management
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Sepsis has recently been defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Initial management, as defined by the Surviving Sepsis Guidelines (SSG), consists of source control, early broad-spectrum antibiotics, and hemodynamic stabilization.
Hemodynamic instability can persist following fluid resuscitation. Although circulatory dysfunction is considered the main determinant of hemodynamic instability in septic shock, the presence of a coexisting cardiac dysfunction may play a very important role in the pathogenesis of hemodynamic failure and response to treatment. Septic shock is characterized by hypotension with important peripheral vasodilatation; therefore a possible cardiopathy might not be immediately recognized (Guarracino et al., Crit Care 18(2):R80, 2014). In septic shock sepsis-induced myocardium depression is the main cause of cardiac dysfunction even though, in the critically ill patient, it is not uncommon that a cardiogenic shock preexisted the septic shock. The circulatory dysfunction results in the maldistribution of blood flow and oxygen supply to the various organs with consequent cellular damage.
The complexity of septic shock from a hemodynamic point of view requires careful evaluation before starting the treatments. In this scenario, the combination of pathophysiological information provided by echocardiography with those from traditional hemodynamic monitoring allows the clinician to manage the resuscitation in the critical patient with septic shock in a more “tailored” way.
KeywordsSepsis Septic shock Cardiovascular function Pathophysiology Resuscitation Volume Vasopressors Ventriculo-arterial coupling Arterial elastance Ventricular elastance Hemodynamics
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