Case scenario for fluid therapy in septic shock

Abstract

Septic shock represents a profound systemic inflammatory derangement with components of functional hypovolemia, altered oxygen delivery, myocardial dysfunction, peripheral vasoplegia, and diffuse capillary leak. In this case scenario, the patient exhibited all of the aforementioned findings with lactic acidosis, elevated troponin, persistent hypotension despite vasopressor use, acute kidney injury, and pneumonitis presumably from his sepsis. Concurrent with source control and early antibiotic administration, early and aggressive fluid therapy, maintenance of tissue perfusion, and judicious application of inotropic support remain a cornerstone of septic shock therapy. Early goal-directed therapy (EGDT) has been widely adopted as a protocolized methodology to ensure early and aggressive fluid resuscitation (in addition to vasopressors, steroids, and timed antibiotic administration). It has been postulated that bundle implementation may improve survival. Perioperative goal-directed fluid management may also affect outcome.