• Anousone Daulasim, Antoine Vieillard-Baron, and Guillaume Geri.
• Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, INSERM UMR 1018, Clinical Epidemiology Team, CESP, Paris-Saclay University, Villejuif, France.
• Curr Opin Crit Care. 2021 Jun 1; 27 (3): 290-297.

Purpose Of ReviewRecent studies have failed to show significant benefit from a uniform strategy, suggesting that hemodynamic management must be individually adapted in septic shock depending on different phenotypes. Different approaches that may be used to this end will be discussed.Recent FindingsFluid management is a cornerstone of resuscitation, as the positive fluid balance has been associated with higher mortality and right ventricular failure. Myocardial evaluation is mandatory, as sepsis patients may present with a hyperkinetic state, left ventricular (systolic and diastolic) and/or right ventricular dysfunction, the latter being associated with higher mortality. Statistical approaches with the identification of hemodynamic clusters based on echocardiographic and clinical parameters might be integrated into daily practice to develop precision medicine. Such approaches may also predict the progression of septic shock.SummaryDifferent hemodynamic phenotypes can occur at any stage of sepsis and be associated with one another. The clinician must regularly assess dynamic changes in phenotypes in septic shock patients. Statistical approaches based on machine learning need to be validated by prospective studies.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

14 keywords...

hide…