title: Current haemodynamic management of septic shock.
abstract: Early and adequate resuscitation of patients with acute circulatory failure is important to restore the balance between oxygen needs and delivery. Haemodynamic management can globally be separated into three categories according to the VIP mnemonic - Ventilate, Infuse, Pump - which should be considered simultaneously in the patient with shock. Sufficient oxygen should be given early, and endotracheal intubation and mechanical ventilation performed without hesitation if there is any indication that oxygenation is inadequate. Fluids should be administered using the SOSD mnemonic - Salvage, Optimization, Stabilization, De-escalation. After initial liberal administration, ongoing requirements should be guided by repeated fluid challenges using a combination of balanced crystalloid solutions and colloid. Noradrenaline is the vasopressor of choice and should be started early. Dobutamine may be needed to improve myocardial contractility and cardiac output. Haemodynamic support should be personalized according to individual patient characteristics and global and regional parameters of haemodynamic and oxygenation status.
authors.affiliation: Erasme University Hospital, université libre de Bruxelles, Department of Intensive Care, route de Lennik 808, 1070 Brussels, Belgium. Electronic address: jlvincen@ulb.ac.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Erasme University Hospital, université libre de Bruxelles, Department of Intensive Care, route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: Diego
authors.initials: D
authors.lastname: Orbegozo Cortés
authors.affiliation: Erasme University Hospital, université libre de Bruxelles, Department of Intensive Care, route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: Angela
authors.initials: A
authors.lastname: Acheampong
mesh_terms: D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D008991:Monitoring, Physiologic; D010102:Oxygen Inhalation Therapy; D012772:Shock, Septic / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*