Hemodynamic monitoring in sepsis—a conceptual framework of macro‐ and microcirculatory alterations

Abstract

Circulatory failure in sepsis is common and places a considerable burden on healthcare systems. It is associated with an increased likelihood of mortality, and timely recognition is a pre-requisite to ensure optimum results. While there is consensus that aggressive source control, adequate antimicrobial therapy and hemodynamic management constitute crucial determinants of out-come, discussion remains about the best way to achieve each of these core principles. Sound cardiovascular support rests on tailored fluid resuscitation and vasopressor therapy. To this end, an over-arching framework to improve cardiovascular dynamics has been a recurring theme in modern critical care. The object of this review is to examine the nature of one such framework that acknowl-edges the growing importance of adaptive hemodynamic support combining macro‐ and microhe-modynamic variables to produce adequate tissue perfusion.