Sepsis pp 219-224 | Cite as

Hemodynamic Support in Sepsis

  • Jean-Louis VincentEmail author
Part of the Respiratory Medicine book series (RM)


Hemodynamic support in sepsis is more complex than it may seem at initial glance with multiple components that need to be considered, including choice of fluid and vasoactive agent, which variables to monitor and which targets to aim for. Further complexity is added by the fact that the overall hemodynamic status of any patient is a reflection not only of their macro-hemodynamic situation but also of their micro-hemodynamics. Each patient must therefore be assessed and treated on an individual basis to ensure that the most appropriate support is offered. Importantly, hemodynamic status is a dynamic event, changing with the evolution of the disease and a patient’s response to treatment so that interventions must be repeatedly adapted and reassessed.


Sepsis Septic shock Sepsis treatment Sepsis hemodynamics Vasopressors Critical care Systemic inflammatory response syndrome 


  1. 1.
    De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002;166:98–104.Google Scholar
  2. 2.
    Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004;32:1825–31.Google Scholar
  3. 3.
    Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care. 2015;19:251.Google Scholar
  4. 4.
    Sirvent JM, Ferri C, Baro A, Murcia C, Lorencio C. Fluid balance in sepsis and septic shock as a determining factor of mortality. Am J Emerg Med. 2015;33:186–9.Google Scholar
  5. 5.
    Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369:1726–34.Google Scholar
  6. 6.
    Hoste EA, Maitland K, Brudney CS, Mehta R, Vincent JL, Yates D, et al. Four phases of intravenous fluid therapy: a conceptual model. Br J Anaesth. 2014;113:740–7.Google Scholar
  7. 7.
    Vincent JL, Weil MH. Fluid challenge revisited. Crit Care Med. 2006;34:1333–7.Google Scholar
  8. 8.
    Katz AM. Ernest Henry Starling, his predecessors, and the “Law of the Heart”. Circulation. 2002;106:2986–92.Google Scholar
  9. 9.
    Vincent JL. Let’s give some fluid and see what happens" versus the "mini-fluid challenge. Anesthesiology. 2011;115:455–6.Google Scholar
  10. 10.
    Monnet X, Teboul JL. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015;19:18.Google Scholar
  11. 11.
    Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37:2642–7.Google Scholar
  12. 12.
    Vincent JL, Rhodes A, Perel A, Martin GS, Della Rocca G, Vallet B, et al. Clinical review: update on hemodynamic monitoring—a consensus of 16. Crit Care. 2011;15:229.Google Scholar
  13. 13.
    Orbegozo Cortes D, Gamarano Barros T, Njimi H, Vincent JL. Crystalloids versus colloids: exploring differences in fluid requirements by systematic review and meta-regression. Anesth Analg. 2015;120:389–402.Google Scholar
  14. 14.
    Finfer S, McEvoy S, Bellomo R, McArthur C, Myburgh J, Norton R. Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis. Intensive Care Med. 2011;37:86–96.Google Scholar
  15. 15.
    Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370:1412–21.Google Scholar
  16. 16.
    Serpa Neto A, Veelo DP, Peireira VG, de Assuncao MS, Manetta JA, Esposito DC, et al. Fluid resuscitation with hydroxyethyl starches in patients with sepsis is associated with an increased incidence of acute kidney injury and use of renal replacement therapy: a systematic review and meta-analysis of the literature. J Crit Care. 2014;29:185–7.Google Scholar
  17. 17.
    Orbegozo Cortes D, Rayo Bonor A, Vincent JL. Isotonic crystalloid solutions: a structured review of the literature. Br J Anaesth. 2014;112:968–81.Google Scholar
  18. 18.
    Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012;308:1566–72.Google Scholar
  19. 19.
    Reddy S, Weinberg L, Young P. Crystalloid fluid therapy. Crit Care. 2016;20:59.Google Scholar
  20. 20.
    Bai X, Yu W, Ji W, Lin Z, Tan S, Duan K, et al. Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care. 2014;18:532.Google Scholar
  21. 21.
    De Backer D, Aldecoa C, Njimi H, Vincent JL. Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis. Crit Care Med. 2012;40:725–30.Google Scholar
  22. 22.
    Levy B. Bench-to-bedside review: is there a place for epinephrine in septic shock? Crit Care. 2005;9:561–5.Google Scholar
  23. 23.
    He X, Su F, Taccone FS, Laporte R, Kjolbye AL, Zhang J, et al. A selective V1A receptor agonist, selepressin, is superior to arginine vasopressin and to norepinephrine in ovine septic shock. Crit Care Med. 2016;44(1):23–31.Google Scholar
  24. 24.
    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.Google Scholar
  25. 25.
    Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370:1683–93.Google Scholar
  26. 26.
    Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496–506.Google Scholar
  27. 27.
    Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–11.Google Scholar
  28. 28.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.Google Scholar
  29. 29.
    De Backer D, Vincent JL. Early goal-directed therapy: do we have a definitive answer? Intensive Care Med. 2016;42:1048.Google Scholar
  30. 30.
    Vincent JL. The future of critical care medicine: integration and personalization. Crit Care Med. 2016;44:386–9.Google Scholar
  31. 31.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.Google Scholar
  32. 32.
    Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32:1637–42.Google Scholar
  33. 33.
    Liu V, Morehouse JW, Soule J, Whippy A, Escobar GJ. Fluid volume, lactate values, and mortality in sepsis patients with intermediate lactate values. Ann Am Thorac Soc. 2013;10:466–73.Google Scholar
  34. 34.
    Dettmer M, Holthaus CV, Fuller BM. The impact of serial lactate monitoring on emergency department resuscitation interventions and clinical outcomes in severe sepsis and septic shock: an observational cohort study. Shock. 2015;43:55–61.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Vincent JL. Serial blood lactate levels reflect both lactate production and clearance. Crit Care Med. 2015;43:e209.CrossRefPubMedGoogle Scholar
  36. 36.
    Shapiro NI, Angus DC. A review of therapeutic attempts to recruit the microcirculation in patients with sepsis. Minerva Anestesiol. 2014;80:225–35.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Intensive Care, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium

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