Holistic Monitoring and Treatment in Septic Shock

Sepsis-related circulatory dysfunction is usually manifested as an early hypovolemic state that can be reversed with initial fluid resuscitation. If not reversed early, this can progress into a persistent circulatory dysfunction. In contrast to a quite predictable course during the initial phase, persistent circulatory dysfunction is a complex and heterogeneous syndrome. All individual perfusion parameters have extensive limitations to adequately reflect tissue perfusion status in this phase. However, a multimodal approach integrating observation, macrohemodynamics, metabolic parameters, and peripheral and eventually microcirculatory perfusion parameters can overcome their individual limitations. This proposal may provide a holistic understanding of the predominant underlying mechanisms of hypoperfusion and lead to individualized and physiologically oriented therapeutic strategies.