CHEST Guidelines-Outcomes-Using-Fluid-Responsiveness-to-Manage-Flui

Outcomes-Using-Fluid-Responsiveness-to-Manage-Flui

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The letter to the editor discusses fluid management strategies in early septic shock treatment, focusing on fluid responsiveness-based resuscitation. Chaudhuri et al. previously highlighted concerns over determining appropriate fluid administration and evaluating fluid responsiveness using cardiac output changes and maneuvers like passive leg raising. However, Kenneth Nugent and colleagues note that these approaches have limitations. They involve complex measurements, like echocardiographic assessment of stroke volume, that require significant expertise. Moreover, a key issue with relying on fluid responsiveness to guide resuscitation is its unclear impact on mortality. A meta-analysis by Ehrman et al. involving four clinical trials with 365 patients showed no clear mortality reduction for patients managed this way compared to usual care, with an odds ratio of 0.87, suggesting no significant difference.<br /><br />The authors propose an alternative approach focusing on the early administration of vasopressors like norepinephrine for patients with septic shock. This strategy was shown in a randomized trial by Permpikul et al. to enhance shock control and reduce complications such as pulmonary edema and arrhythmias but did not influence 28-day mortality.<br /><br />In conclusion, Nugent and colleagues emphasize that sepsis patients often present complex cases with rapidly changing clinical statuses. Factors influencing their initial trajectory are multifaceted and extend beyond fluid responsiveness. Thus, while fluid responsiveness is an important consideration, it should not be the sole determinant in septic shock management. Instead, a comprehensive approach, potentially including early vasopressor use, may better address patient needs.

Keywords

septic shock

fluid management

fluid responsiveness

resuscitation

vasopressors

norepinephrine

mortality

cardiac output

echocardiographic assessment

sepsis treatment