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Fluids or vasopressors for the initial resuscitation of septic shock
Intravenous fluid resuscitation is recommended first-line treatment for sepsis-associated hypotension and/or hypoperfusion. The rationale is to restore circulating volume and optimize cardiac output in the setting of shock. Nonetheless, there is limited high-level evidence to support this practice....
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9729725/ https://www.ncbi.nlm.nih.gov/pubmed/36507525 http://dx.doi.org/10.3389/fmed.2022.1069782 |
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author | Macdonald, Stephen Peake, Sandra L. Corfield, Alasdair R. Delaney, Anthony |
author_facet | Macdonald, Stephen Peake, Sandra L. Corfield, Alasdair R. Delaney, Anthony |
author_sort | Macdonald, Stephen |
collection | PubMed |
description | Intravenous fluid resuscitation is recommended first-line treatment for sepsis-associated hypotension and/or hypoperfusion. The rationale is to restore circulating volume and optimize cardiac output in the setting of shock. Nonetheless, there is limited high-level evidence to support this practice. Over the past decade emerging evidence of harm associated with large volume fluid resuscitation among patients with septic shock has led to calls for a more conservative approach. Specifically, clinical trials undertaken in Africa have found harm associated with initial fluid resuscitation in the setting of infection and hypoperfusion. While translating these findings to practice in other settings is problematic, there has been a re-appraisal of current practice with some recommending earlier use of vasopressors rather than repeated fluid boluses as an alternative to restore perfusion in septic shock. There is consequently uncertainty and variation in practice. The question of fluids or vasopressors for initial resuscitation in septic shock is the subject of international multicentre clinical trials. |
format | Online Article Text |
id | pubmed-9729725 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97297252022-12-09 Fluids or vasopressors for the initial resuscitation of septic shock Macdonald, Stephen Peake, Sandra L. Corfield, Alasdair R. Delaney, Anthony Front Med (Lausanne) Medicine Intravenous fluid resuscitation is recommended first-line treatment for sepsis-associated hypotension and/or hypoperfusion. The rationale is to restore circulating volume and optimize cardiac output in the setting of shock. Nonetheless, there is limited high-level evidence to support this practice. Over the past decade emerging evidence of harm associated with large volume fluid resuscitation among patients with septic shock has led to calls for a more conservative approach. Specifically, clinical trials undertaken in Africa have found harm associated with initial fluid resuscitation in the setting of infection and hypoperfusion. While translating these findings to practice in other settings is problematic, there has been a re-appraisal of current practice with some recommending earlier use of vasopressors rather than repeated fluid boluses as an alternative to restore perfusion in septic shock. There is consequently uncertainty and variation in practice. The question of fluids or vasopressors for initial resuscitation in septic shock is the subject of international multicentre clinical trials. Frontiers Media S.A. 2022-11-24 /pmc/articles/PMC9729725/ /pubmed/36507525 http://dx.doi.org/10.3389/fmed.2022.1069782 Text en Copyright © 2022 Macdonald, Peake, Corfield and Delaney. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Macdonald, Stephen Peake, Sandra L. Corfield, Alasdair R. Delaney, Anthony Fluids or vasopressors for the initial resuscitation of septic shock |
title | Fluids or vasopressors for the initial resuscitation of septic shock |
title_full | Fluids or vasopressors for the initial resuscitation of septic shock |
title_fullStr | Fluids or vasopressors for the initial resuscitation of septic shock |
title_full_unstemmed | Fluids or vasopressors for the initial resuscitation of septic shock |
title_short | Fluids or vasopressors for the initial resuscitation of septic shock |
title_sort | fluids or vasopressors for the initial resuscitation of septic shock |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9729725/ https://www.ncbi.nlm.nih.gov/pubmed/36507525 http://dx.doi.org/10.3389/fmed.2022.1069782 |
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