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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 4/2019

11.02.2019 | Review

Challenges in the management of septic shock: a narrative review

verfasst von: Daniel De Backer, Maurizio Cecconi, Jeffrey Lipman, Flavia Machado, Sheila Nainan Myatra, Marlies Ostermann, Anders Perner, Jean-Louis Teboul, Jean-Louis Vincent, Keith R. Walley

Erschienen in: Intensive Care Medicine | Ausgabe 4/2019

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Abstract

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.
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Metadaten
Titel
Challenges in the management of septic shock: a narrative review
verfasst von
Daniel De Backer
Maurizio Cecconi
Jeffrey Lipman
Flavia Machado
Sheila Nainan Myatra
Marlies Ostermann
Anders Perner
Jean-Louis Teboul
Jean-Louis Vincent
Keith R. Walley
Publikationsdatum
11.02.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 4/2019
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05544-x

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