Resuscitation of the patient in septic shock

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. The mainstays of management include early recognition, source control, antibiotic treatment and effective resuscitation. In 2001, early goal-directed therapy (EGDT), a protocol for sepsis resuscitation, demonstrated decreased mortality among emergency department patients randomized to 6 h of EGDT versus usual care. EGDT utilized intravenous fluids, vasopressors, inotropes, and blood transfusions to achieve specific central hemodynamic goals. While this practice was adopted in international guidelines, concerns remain about the validity of this approach. Subsequent multisite randomized controlled trials published in 2014 and 2015 have demonstrated no mortality benefit with the use of EGDT versus usual care. The Surviving Sepsis Campaign (SSC) currently provides best practice guidelines for resuscitation of patients with sepsis and septic shock. Crystalloid is the initial fluid of choice for sepsis; albumin may be safely used as an adjunct for large volume resuscitation in the absence of traumatic injury. SSC endorses quantitative resuscitation within the first 6 h of care to achieve specific central hemodynamic goals and normalization of lactate. Sepsis resuscitation remains an active area for research investigation, and evidence-based guidelines will continue to reflect advances in knowledge.