Evolving Management Practices for Early Sepsis-induced Hypoperfusion: A Narrative Review

This review discusses five areas of evolving practices in the management of early sepsis-induced hypoperfusion: fluid resuscitation volume, the timing of vasopressor initiation, resuscitation targets, route of vasopressor administration, and use of invasive blood pressure monitoring. The use of smaller-volume resuscitation and earlier vasopressor initiation is becoming more common due to concerns about the potential harms of fluid overload. Trials exploring fluid-restrictive and vasopressor-early strategies are shedding light on their safety and potential benefits. Lowering blood pressure targets, particularly in older patients, is seen as a way to prevent fluid overload and minimize vasopressor exposure. The need for central administration of vasopressors is being questioned, and peripheral vasopressor use is increasing. Similarly, the use of invasive blood pressure monitoring with arterial catheters is suggested but not universally accepted, as blood pressure cuffs can often suffice. Overall, the management of early sepsis-induced hypoperfusion is moving toward fluid-sparing and less-invasive approaches, but more research is needed to further optimize resuscitation strategies.