Hemodynamic Management of Septic Shock: Is it Time for 'Individual Goal-Directed Hemodynamic Therapy' and for Specifically Targeting the Microcirculation?

TY - JOUR

T1 - Hemodynamic Management of Septic Shock: Is it Time for 'Individual Goal-Directed Hemodynamic Therapy' and for Specifically Targeting the Microcirculation?

AU - Saugel, Bernd

AU - Trepte, Constantin J

AU - Heckel, Kai

AU - Wagner, Julia Y

AU - Reuter, Daniel A

PY - 2015/6

Y1 - 2015/6

N2 - Septic shock is a life-threatening condition in both critically ill medical patients and surgical patients during the perioperative phase. In septic shock, specific alterations in global cardiovascular dynamics (i.e., the macrocirculation) and in the microcirculatory blood flow (i.e., the microcirculation) have been described. However, the presence and degree of microcirculatory failure is in part independent from systemic macrohemodynamic variables. Macrocirculatory and microcirculatory failure can independently induce organ dysfunction. We review current diagnostic and therapeutic approaches for the assessment and optimization of both the macrocirculation and the microcirculation in septic shock.There are various technologies for the determination of macrocirculatory hemodynamic variables. We discuss the data on early goal-directed therapy for the resuscitation of the macrocirculation. In addition, we describe the concept of 'individualized goal-directed hemodynamic therapy'.Technologies to assess the local microcirculation are also available. However, adequate resuscitation goals for the optimization of the microcirculation still need to be defined. At present, we are not ready to specifically monitor and target the microcirculation in clinical routine outside of studies.In the future, concepts for an integrative approach for individual hemodynamic management of the macrocirculation and in parallel the microcirculation might constitute a huge opportunity to define additional resuscitation endpoints in septic shock.

AB - Septic shock is a life-threatening condition in both critically ill medical patients and surgical patients during the perioperative phase. In septic shock, specific alterations in global cardiovascular dynamics (i.e., the macrocirculation) and in the microcirculatory blood flow (i.e., the microcirculation) have been described. However, the presence and degree of microcirculatory failure is in part independent from systemic macrohemodynamic variables. Macrocirculatory and microcirculatory failure can independently induce organ dysfunction. We review current diagnostic and therapeutic approaches for the assessment and optimization of both the macrocirculation and the microcirculation in septic shock.There are various technologies for the determination of macrocirculatory hemodynamic variables. We discuss the data on early goal-directed therapy for the resuscitation of the macrocirculation. In addition, we describe the concept of 'individualized goal-directed hemodynamic therapy'.Technologies to assess the local microcirculation are also available. However, adequate resuscitation goals for the optimization of the microcirculation still need to be defined. At present, we are not ready to specifically monitor and target the microcirculation in clinical routine outside of studies.In the future, concepts for an integrative approach for individual hemodynamic management of the macrocirculation and in parallel the microcirculation might constitute a huge opportunity to define additional resuscitation endpoints in septic shock.

U2 - 10.1097/SHK.0000000000000345

DO - 10.1097/SHK.0000000000000345

M3 - SCORING: Journal article

C2 - 25643016

VL - 43

SP - 522

EP - 529

JO - SHOCK

JF - SHOCK

SN - 1073-2322

IS - 6

ER -