• Daniel De Backer, Maurizio Cecconi, Jeffrey Lipman, Flavia Machado, Sheila Nainan Myatra, Marlies Ostermann, Anders Perner, Jean-Louis Teboul, Jean-Louis Vincent, and Keith R Walley.
• Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium. ddebacke@ulb.ac.be.
• Intensive Care Med. 2019 Apr 1; 45 (4): 420-433.

AbstractWhile guidelines provide important information on how to approach a patient in septic shock, "many challenges remain" for the management of these patients. In this narrative review, the panel discusses the challenges in identifying the right hemodynamic target, optimization of fluid therapy, selection of vasopressor agents, identification of patients who may benefit from inotropic agents or on the contrary beta-blockade, and use of steroids. The place for microcirculation-targeted therapy is debated as well as the use of alternative techniques (blood purification) and therapies (vitamin C). The implications of hemodynamic alterations on antibiotic doses is discussed. Finally, the specific challenges in low- and middle-income countries are addressed. Ongoing trials address some of these challenges, but many uncertainties will remain, and individualized therapies based on careful clinical assessment will continue to be essential to optimizing the care of patients with septic shock.

22 keywords...

hide…