Advanced Hemodynamic Management in Patients with Septic Shock

Figure 1

Algorithm  1—treatment algorithm for the first 24 hours of hemodynamic management. Hemodynamic therapeutic interventions in Algorithm  1 include fluids (crystalloids), a vasopressor (norepinephrine), and an inotrope (dobutamine) titrated according to extravascular lung water index (EVLWI) and cardiac index (CI). Crystalloids are given as a bolus of 500 mL (fluid challenge). We define fluid responsiveness as an increase in CI of ≥15% or an increase in mean arterial pressure (MAP) of ≥15% or a cumulative increase in CI and MAP of ≥20% (given that the dose of vasopressors is kept constant). EVLWI is complemented by the arterial partial pressure of oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) ratio to account for the individual pulmonary function of the patient.