Hemodynamic failure during sepsis: What clinicians and researchers must know

Sepsis remains the most common syndrome in intensive care units and the leading cause of mortality. This narrative review aims to synthesize the literature that should be known by most intensivists. After a brief overview of pathophysiology, this review summarizes the data on fluid resuscitation and vasopressors. The preference to use a personalized approach for fluid resuscitation and balanced fluid instead of saline was underlined, although the level of evidence remains weak. For vasopressors, innovative strategies, including an early multimodal approach, have been recently developed to overcome the excess of mortality associated with the use of high doses of norepinephrine. Future advances include an insight into the prediction of hemodynamic failure using monitoring and artificial intelligence, as well as new directions in terms of treatments targeting metabolisms and new pathways. Finally, although the literature in the field is vast, the level of evidence for most interventions is weak to moderate, but the clinical research remains intense.