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Challenges in the management of septic shock: a narrative review

Intensive care medicine, 2019-04, Vol.45 (4), p.420-433 [Peer Reviewed Journal]

Springer-Verlag GmbH Germany, part of Springer Nature 2019 ;COPYRIGHT 2019 Springer ;Intensive Care Medicine is a copyright of Springer, (2019). All Rights Reserved. ;Distributed under a Creative Commons Attribution 4.0 International License ;ISSN: 0342-4642 ;EISSN: 1432-1238 ;DOI: 10.1007/s00134-019-05544-x ;PMID: 30741328

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Title:
Challenges in the management of septic shock: a narrative review
Author: De Backer, Daniel ; Cecconi, Maurizio ; Lipman, Jeffrey ; Machado, Flavia ; Myatra, Sheila Nainan ; Ostermann, Marlies ; Perner, Anders ; Teboul, Jean-Louis ; Vincent, Jean-Louis ; Walley, Keith R.
Subjects: Anesthesiology ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Ascorbic acid ; Care and treatment ; Clinical trials ; Critical Care Medicine ; Disease Management ; Emergency Medicine ; Fluid Therapy - methods ; Hemodynamics ; Hemodynamics - drug effects ; Hemodynamics - physiology ; Humans ; Intensive ; Intensive care ; Life Sciences ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Methylene blue ; Optimization ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Purification ; Review ; Sepsis ; Septic shock ; Shock, Septic - complications ; Shock, Septic - therapy ; Steroid hormones ; Steroids ; Therapy ; Vasoconstrictor Agents - pharmacology ; Vasoconstrictor Agents - therapeutic use ; Vasoconstrictors ; Vitamin C
Is Part Of: Intensive care medicine, 2019-04, Vol.45 (4), p.420-433
Description: While 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.
Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
Language: English
Identifier: ISSN: 0342-4642
EISSN: 1432-1238
DOI: 10.1007/s00134-019-05544-x
PMID: 30741328
Source: MEDLINE
ProQuest Central

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Challenges in the management of septic shock: a narrative review

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