{ "schemaVersion": 2, "eyebrow": "Critical Care", "title": "Sepsis Fluid Reassessment", "summary": "After initial crystalloid resuscitation for sepsis-induced hypoperfusion, reassess perfusion, fluid responsiveness, and congestion before each additional bolus. Passive leg raising with stroke-volume or cardiac-output measurement is the most broadly applicable dynamic test; persistent hypotension requires prompt vasopressor support rather than reflexive fluid loading.", "seoDescription": "Practical reassessment after initial sepsis fluids: dynamic tests, passive leg raising, perfusion endpoints, fluid-stop rules, and vasopressor escalation.", "clinicalQuestion": "How should clinicians reassess fluid need after initial crystalloid resuscitation in sepsis-induced hypoperfusion or septic shock?", "specialty": "Critical Care Medicine", "audience": "U.S. physicians and medical trainees", "tags": [ "sepsis fluid resuscitation", "septic shock reassessment", "passive leg raise", "fluid responsiveness", "vasopressors", "dynamic hemodynamic monitoring" ], "keyTakeaways": [ "Use crystalloid for initial sepsis resuscitation; the Surviving Sepsis Campaign recommendation cited in current reviews is 30 mL/kg IV crystalloid within the first 3 hours for sepsis-induced hypoperfusion or septic shock. [8][10][15]", "After the initial bolus, do not use central venous pressure, mean arterial pressure, tachycardia, or other static filling surrogates alone to decide on more fluid; assess a dynamic response to preload and contemporaneous tissue perfusion. [2][4][11]", "Perform passive leg raising with a real-time stroke-volume or cardiac-output readout when feasible; it can be used in spontaneously breathing and mechanically ventilated patients, but abdominal or intracranial hypertension and major hip or lower-extremity trauma limit interpretation or feasibility. [6][18]", "A positive fluid-responsiveness test predicts increased stroke volume or cardiac output after fluid, not necessarily improved outcomes; stop repeated boluses when preload augmentation does not improve flow or when congestion emerges. [11][19]", "For persistent MAP below 65 mm Hg after initial resuscitation, initiate and titrate norepinephrine rather than continuing indiscriminate fluid administration; large peripheral IV access can facilitate early norepinephrine use. [20][21]" ], "sections": [ { "id": "reassessment-trigger", "eyebrow": "First reassessment", "heading": "When to reassess after the initial fluid bolus", "intro": "Reassessment determines whether the next intervention should be fluid, vasopressor, or treatment of another shock mechanism.", "paragraphs": [ "For sepsis-induced hypoperfusion or septic shock, give initial IV crystalloid resuscitation promptly; current Surviving Sepsis Campaign guidance cited in contemporary reviews recommends at least 30 mL/kg within 3 hours. Reassess immediately after that initial resuscitation and earlier if respiratory status deteriorates, oxygen requirement rises, or hypotension persists. [10][15][24]", "At reassessment, separate three questions: is tissue perfusion still abnormal, will preload augmentation increase cardiac output, and is further fluid likely to worsen edema or pulmonary congestion? Persistent hypotension alone does not establish fluid deficit because septic shock combines vasodilation, capillary leak, and variable myocardial dysfunction. [16][20]", "Repeat bedside examination and basic perfusion measures serially, including urine output, capillary refill time, skin temperature gradients, mottling, lactate, blood pressure, and mental status. These measures are sensitive for hypoperfusion but individually have low specificity; integrate them with a dynamic flow assessment before ordering another bolus. [6]" ], "bullets": [ "Recheck lactate when the initial value is at least 2 mmol/L to assess the response to resuscitation. [15]", "Treat MAP below 65 mm Hg or systolic blood pressure below 90 mm Hg as an immediate reassessment trigger; evaluate fluid responsiveness while preparing norepinephrine when hypotension is persistent or severe. [20][21]", "Actively look for a competing or mixed shock state when cardiac output is low, pulmonary edema is present, or the hemodynamic response to preload is absent. [4][14][21]" ], "subsections": [], "table": { "caption": "Post-bolus reassessment questions and actions in sepsis-induced hypoperfusion. [6][11][20]", "columns": [ "Question", "Bedside assessment", "Interpretation", "Next action" ], "rows": [ [ "Is perfusion still inadequate?", "Trend MAP, lactate, urine output, capillary refill, skin temperature gradient, and mottling. [6][15]", "Persistent abnormality supports ongoing resuscitation but does not identify fluid as the correct intervention. [6][11]", "Perform a dynamic preload test and reassess for vasoplegia, low cardiac output, bleeding, obstruction, or uncontrolled infection." ], [ "Will fluid increase flow?", "Passive leg raise with real-time stroke-volume or cardiac-output measurement; echocardiographic output assessment is reliable. [6][18]", "An increase in flow during the maneuver supports fluid responsiveness. [6][18]", "If perfusion remains abnormal and no congestion is evident, give a measured crystalloid bolus with immediate repeat assessment." ], [ "Is vasodilation driving hypotension?", "MAP remains below 65 mm Hg or SBP below 90 mm Hg despite initial fluid resuscitation. [20][21]", "Additional fluid may not correct pressure when vascular tone is inadequate. [16][20]", "Start norepinephrine and titrate to a MAP of at least 65 mm Hg while continuing source-directed sepsis management. [20][21]" ], [ "Should fluids stop?", "No flow increase with preload augmentation, rising filling pressures without improved perfusion, or clinical fluid overload. [11][14][17]", "Further boluses are unlikely to improve cardiac output and may add harmful extravascular edema. [11][20]", "Stop routine boluses; use vasopressor support for hypotension and reassess cardiac function and alternative causes of hypoperfusion." ] ] } }, { "id": "dynamic-fluid-responsiveness", "eyebrow": "Preload testing", "heading": "Choose a dynamic test before additional fluid", "intro": "Dynamic tests estimate whether transient preload augmentation increases stroke volume or cardiac output.", "paragraphs": [ "Passive leg raising is the preferred reassessment maneuver when a real-time flow measurement is available. It transiently transfers venous blood from the legs to the central circulation without committing the patient to an administered bolus, and it is feasible in patients with or without invasive mechanical ventilation. Measure stroke volume or cardiac output during the maneuver rather than relying on an isolated pretest value. [6][18]", "Transthoracic echocardiography can provide the required flow readout during passive leg raising. Where ultrasound-based output measurement is unavailable, change in pulse pressure or capillary refill time during passive leg raising has shown useful performance, but these alternatives should be interpreted in the full clinical context. [6]", "Do not substitute a static central venous pressure, pulmonary capillary wedge pressure, left-ventricular end-diastolic area, MAP, or heart rate for a dynamic fluid-responsiveness assessment. These static indices have limited ability to distinguish fluid responders from nonresponders. [4][11]" ], "bullets": [ "Avoid or qualify passive leg raising in abdominal hypertension, intracranial hypertension, traumatic hip fracture, or lower-extremity fractures. [6]", "Pulse-pressure variation and stroke-volume variation are most applicable during controlled positive-pressure ventilation with sedation, sinus rhythm, and tidal volumes of at least 8 mL/kg; atrial fibrillation, ectopy, spontaneous respiratory effort, and low tidal-volume ventilation reduce reliability. [2][4]", "Inferior vena cava respiratory variation has the same important ventilatory and rhythm-related constraints and should not be interpreted as a stand-alone measure of intravascular volume. [2][4]", "A mini-fluid challenge is an alternative dynamic approach when passive leg raising cannot be performed, provided stroke volume or cardiac output can be measured serially. [6]" ], "subsections": [ { "heading": "Interpret a positive test correctly", "paragraphs": [ "Fluid responsiveness means cardiac output or stroke volume is likely to rise after fluid administration; it does not prove that the patient needs fluid, that organ perfusion will improve, or that outcome will improve. A meta-analysis of four sepsis trials totaling 365 patients found no mortality reduction when fluid resuscitation was managed by fluid responsiveness compared with usual care. [11][19]", "Use a positive passive leg raise or other valid dynamic test as permission for a cautious, reassessed crystalloid bolus only when ongoing hypoperfusion is present and the expected benefit exceeds congestion risk. A negative test should redirect treatment toward vasopressors for vasoplegia, echocardiographic assessment for low-output states, and correction of other causes of hypoperfusion. [6][11][20]" ], "bullets": [] } ], "table": { "caption": "Selection limits of commonly used fluid-responsiveness assessments. [2][4][6]", "columns": [ "Method", "Best-use setting", "Important limitation", "Clinical use" ], "rows": [ [ "Passive leg raise with stroke volume or cardiac output", "Spontaneously breathing or mechanically ventilated patient with real-time flow measurement. [6][18]", "Limited by abdominal or intracranial hypertension and major hip or lower-extremity trauma. [6]", "Preferred reversible preload challenge before another bolus." ], [ "Pulse-pressure variation or stroke-volume variation", "Fully passive, volume-controlled mechanical ventilation, sinus rhythm, and tidal volume at least 8 mL/kg. [2][4]", "Unreliable with arrhythmia, spontaneous effort, or low tidal-volume ventilation. [2][4]", "Use only when physiologic prerequisites are met." ], [ "Inferior vena cava variation", "Selected mechanically ventilated patients meeting ventilatory prerequisites. [2][4]", "Affected by ventilation conditions, tidal volume, and lung compliance; not a universal test. [2][5]", "Supportive finding, not a stand-alone fluid order." ], [ "Static filling surrogates", "Readily available but poor discriminators of fluid responsiveness. [4][11]", "CVP, PCWP, MAP, tachycardia, and left-ventricular end-diastolic area do not reliably identify responders. [4][11]", "Do not use alone to justify repeated fluid loading." ] ] } }, { "id": "fluid-bolus-and-stop-rules", "eyebrow": "Fluid decisions", "heading": "Give further fluid only as a monitored intervention", "intro": "Each bolus should have a defined physiologic target and a predefined stop rule.", "paragraphs": [ "Use isotonic crystalloid as the initial resuscitation fluid. Current guidance allows buffered crystalloid or saline; reviews cite data associating buffered solutions with fewer major adverse kidney events through 30 days or hospital discharge in critically ill patients than saline. [8][9]", "After initial resuscitation, administer additional fluid as discrete, reassessed boluses rather than an unexamined cumulative volume. In the CLOVERS protocol, rescue crystalloid was administered in 500-mL boluses for severe or refractory hypotension, rising lactate above 4 mmol/L after at least 2 hours of therapy, persistent sinus tachycardia above 130/min for more than 15 minutes, or extreme volume depletion by hemodynamic monitoring. These trial criteria are pragmatic triggers, not universal requirements. [20]", "Stop or slow fluids when preload augmentation fails to improve flow, filling pressures rise without improved tissue perfusion, or clinical volume overload develops. The principal tradeoff is that crystalloid may transiently increase intravascular volume while worsening extravascular edema in the lungs and other organs. [11][14][20]" ], "bullets": [ "Consider albumin only when substantial crystalloid volumes are required; avoid synthetic starches for sepsis resuscitation. [22][24]", "Do not treat a positive dynamic test in isolation: require a concurrent resuscitation target such as persistent hypotension, abnormal peripheral perfusion, oliguria, or an unfavorable lactate trend. [6][11][15]", "When the patient has severely reduced cardiac function, end-stage renal disease, or evidence of fluid overload, individualize the initial and subsequent fluid plan and prioritize frequent reassessment. [17]" ], "subsections": [], "table": { "caption": "Operational stop rules after a post-initial-resuscitation crystalloid bolus. [11][14][20]", "columns": [ "Finding after preload test or bolus", "Meaning", "Action" ], "rows": [ [ "Improved stroke volume or cardiac output and persistent hypoperfusion without congestion. [6][18]", "Fluid responsiveness with a remaining perfusion target.", "Consider another measured crystalloid bolus, then repeat perfusion and flow assessment." ], [ "No increase in stroke volume or cardiac output with passive leg raise or fluid. [6][11]", "Patient is unlikely to benefit hemodynamically from further preload.", "Stop routine fluids; assess vascular tone and cardiac function." ], [ "Rising filling pressures without improved tissue perfusion. [14]", "Further fluid is unlikely to restore effective perfusion.", "Reduce or stop infusion; use alternative hemodynamic support." ], [ "New or worsening fluid overload. [17][20]", "Extravascular fluid accumulation may outweigh any intravascular benefit.", "Stop additional boluses and reassess respiratory and cardiac status." ] ] } }, { "id": "vasopressor-escalation", "eyebrow": "Persistent hypotension", "heading": "Escalate to norepinephrine when pressure remains inadequate", "intro": "Persistent hypotension after initial fluid is a vasopressor decision, not an automatic indication for more volume.", "paragraphs": [ "For MAP below 65 mm Hg or SBP below 90 mm Hg after initial resuscitation, begin norepinephrine and titrate to restore a MAP of at least 65 mm Hg. The CLOVERS protocol targeted MAP from 65 to 75 mm Hg, and early norepinephrine could be administered through a large peripheral IV catheter when central access was not yet available. [20][21]", "Use norepinephrine concurrently with dynamic reassessment rather than waiting for an arbitrary fluid volume when hypotension is profound or refractory. Trial protocols permitted rescue fluid for MAP below 50 mm Hg, SBP below 70 mm Hg, or MAP below 65 mm Hg despite norepinephrine at least 20 mcg/min or 0.25 mcg/kg/min in an 80-kg adult; these thresholds identify severe instability requiring immediate reassessment rather than a mandate to continue fluid. [20]", "If hypotension persists despite fluid and vasopressor therapy, reassess for low cardiac output and mixed shock. In guideline summaries, dobutamine is reserved for low cardiac output persisting despite fluid resuscitation in the setting of combined inotropic and vasopressor support; echocardiographic assessment should guide this branch rather than empirical inotrope use. [14][21]" ], "bullets": [ "Do not use dopamine routinely; guideline summaries restrict it to highly selected circumstances. [13]", "Vasopressin at 0.03 units/min may be added to norepinephrine to raise MAP or reduce norepinephrine dose, but it should not be the initial vasopressor. [13]", "Continue source control and empiric antimicrobial treatment in parallel; hemodynamic normalization without infection control is not adequate sepsis management. [12][13][14]" ], "subsections": [], "table": { "caption": "Hemodynamic branch points after initial crystalloid resuscitation. [13][14][20][21]", "columns": [ "Post-fluid pattern", "Likely dominant problem", "Immediate action" ], "rows": [ [ "MAP below 65 mm Hg with ongoing vasodilatory shock. [20][21]", "Inadequate vascular tone.", "Start and titrate norepinephrine to MAP at least 65 mm Hg. [20][21]" ], [ "Positive dynamic preload response plus persistent hypoperfusion. [6][18]", "Potentially recruitable preload.", "Give a measured crystalloid bolus and immediately reassess flow, perfusion, and congestion." ], [ "Negative dynamic preload response with persistent hypoperfusion. [6][11]", "Fluid-unresponsive shock or mixed physiology.", "Avoid routine additional fluid; evaluate cardiac output and escalate vasoactive support as indicated." ], [ "Low cardiac output after fluid resuscitation with persistent shock. [14][21]", "Sepsis-associated myocardial dysfunction or mixed cardiogenic physiology.", "Perform echocardiographic assessment; consider dobutamine within combined inotrope-vasopressor support when low output persists. [14]" ] ] } }, { "id": "serial-monitoring", "eyebrow": "Ongoing management", "heading": "Repeat reassessment as physiology changes", "intro": "Fluid responsiveness and perfusion targets change over minutes to hours during sepsis treatment.", "paragraphs": [ "Repeat the same objective measurements after every clinically meaningful intervention: fluid bolus, vasopressor escalation, initiation of mechanical ventilation, or abrupt respiratory deterioration. Serial physical examination and basic observations identify evolving hypoperfusion, while repeated dynamic testing limits unnecessary fluid exposure as preload responsiveness changes. [6][11]", "Trend lactate rather than treating a single value as a fluid prescription. Recheck lactate when it is initially at least 2 mmol/L, and interpret an unfavorable trend alongside MAP, peripheral perfusion, urine output, and measured flow. A lactate value above 4 mmol/L that is rising after at least 2 hours of therapy was used as a rescue-fluid trigger in CLOVERS, but it should prompt reassessment of source control, oxygen delivery, vasopressor adequacy, and low-output states as well. [15][20]", "Once shock resolves, transition from resuscitation to avoidance of iatrogenic fluid accumulation. Excess resuscitation fluid commonly requires subsequent diuresis after shock resolution, reinforcing the need to stop fluids as soon as perfusion targets are met or further preload no longer improves flow. [20]" ], "bullets": [ "Document the test used to assess fluid responsiveness, the measured response, the perfusion target, and the reason for each additional bolus.", "Reassess before giving fluid for oliguria alone; urine output may reflect kidney injury, venous congestion, vasopressor effects, or persistent systemic hypoperfusion rather than correctable hypovolemia. [6][11]", "When a patient no longer has an active perfusion deficit, do not continue maintenance resuscitation boluses solely because an earlier dynamic test was positive. [11][19]" ], "subsections": [], "table": { "caption": "Serial monitoring after initial sepsis resuscitation. [6][15][20]", "columns": [ "Interval or trigger", "Repeat measurements", "Decision changed" ], "rows": [ [ "After initial 30 mL/kg crystalloid. [10][15]", "MAP, lactate if initially at least 2 mmol/L, urine output, peripheral perfusion, and dynamic fluid-responsiveness test. [6][15]", "Determines whether to give a measured bolus, start vasopressor support, or evaluate mixed shock." ], [ "After each additional bolus.", "Stroke volume or cardiac output response, MAP, peripheral perfusion, and signs of fluid overload. [6][11]", "Stops further fluid when flow or perfusion does not improve." ], [ "After vasopressor initiation or titration.", "MAP and tissue-perfusion measures; reassess cardiac output if hypoperfusion persists. [6][20][21]", "Distinguishes corrected pressure from persistent low-flow or microcirculatory hypoperfusion." ], [ "After shock resolution.", "Fluid balance and clinical evidence of edema or congestion. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Evaluation of the fluid responsiveness in patients with septic shock by ultrasound plus the passive leg raising test - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0022480417307813", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Crit Care Med\n\n### Inferior vena cava variation compared to pulse contour analysis as predictors of fluid responsiveness: a prospective cohort study\n\n### J Intensive Care Med\n\n### Non-invasive stroke volume measurement and passive leg raising predict volume responsiveness in medical ICU patients", "score": 0.6347929 }, { "number": 2, "title": "Monitoring volume and fluid responsiveness: From static to dynamic indicators - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1521689613000372", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "All currently available methods for assessing fluid responsiveness have limitations, either in their accuracy in predicting fluid responsiveness (as for central venous pressure and central venous oxygen saturation [ScvO2]), the need for advanced technology (as for pulse pressure variation and stroke", "score": 0.5709301 }, { "number": 3, "title": "Analysis of the association between hemodynamic parameters... : Medicine", "detail": "journals.lww.com", "url": "https://journals.lww.com/md-journal/fulltext/2026/01020/analysis_of_the_association_between_hemodynamic.148.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Title: Analysis of the association between hemodynamic parameters... : Medicine\nHemodynamic assessments within 24 hours of ICU admission included sequential organ failure assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure (MAP), systo", "score": 0.5407062 }, { "number": 4, "title": "Stroke volume variation compared with pulse pressure variation and cardiac index changes for prediction of fluid responsiveness in mechanically ventilated patients - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2090730315000031", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Stroke volume variation compared with pulse pressure variation and cardiac index changes for prediction of fluid responsiveness in mechanically ventilated patients - ScienceDirect\n# Original Article Stroke volume variation compared with pulse pressure variation and cardiac index changes for p", "score": 0.51822984 }, { "number": 5, "title": "Comparative Analysis of the Collapsibility Index and Distensibility Index of the Inferior Vena Cava Through Echocardiography with Pulse Pressure Variation That Predicts Fluid Responsiveness in Surgical Patients: An Observational Controlled Trial - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1053077020301294", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "In our meta-analysis, the predictability of ΔSVLRM was greater than that of SVV, which has traditionally been used to assess fluid responsiveness. In addition, we briefly summarized the common indicators currently used to assess fluid responsiveness in various clinical settings, including CVP [45,57", "score": 0.51618147 }, { "number": 6, "title": "How to monitor cardiovascular function in... : Current Opinion in Critical Care", "detail": "journals.lww.com", "url": "https://journals.lww.com/co-criticalcare/fulltext/2021/06000/how_to_monitor_cardiovascular_function_in_critical.11.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "The passive leg raising test is a feasible and affordable tool to guide fluid resuscitation in patients with or without invasive mechanical ventilation, including in resource-limited settings . It is currently still uncertain whether the passive leg raising test has predictive values in all types of", "score": 0.49919498 }, { "number": 7, "title": "Why Has Biomarker-Guided Fluid Resuscitation for... : Critical Care Explorations", "detail": "journals.lww.com", "url": "https://journals.lww.com/ccejournal/fulltext/2025/06000/why_has_biomarker_guided_fluid_resuscitation_for.8.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "were integrated into fluid management strategies, with restrictive fluid approaches—trials such as Conservative vs. Liberal Fluid Therapy in Septic Shock (CLASSIC), Crystalloid Liberal or Vasopressor Early Resuscitation in Sepsis (CLOVERS)—gaining attention for preventing fluid overload. Simultaneou", "score": 0.86713725 }, { "number": 8, "title": "The Surviving Sepsis Campaign: Fluid Resuscitation and ... - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7963440", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "The current SSC guidelines recommend crystalloids as the fluid of choice for initial resuscitation and subsequent intravascular volume replacement in patients with sepsis and septic shock (Table 1) (42). The guidelines also recommend using either buffered solutions or saline for resuscitation, based", "score": 0.7869018 }, { "number": 9, "title": "The surviving sepsis campaign: fluid resuscitation and vasopressor ...", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7917035", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "The current SSC guidelines recommend crystalloids as the fluid of choice for initial resuscitation and subsequent intravascular volume replacement in patients with sepsis and septic shock (Table 1) . The guidelines also recommend using either buffered solutions or saline for resuscitation, based upo", "score": 0.78670514 }, { "number": 10, "title": "Fluid Resuscitation in Patients Presenting with Sepsis: Current Insights", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9719278", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Sepsis is a major global health challenge with an estimated 49 million incident cases and 11 million associated deaths each year.8 Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection, whereas septic shock is a subset of sepsis in which particularl", "score": 0.78572035 }, { "number": 11, "title": "Fluid Management in Sepsis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6532631", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Current Surviving Sepsis Guidelines recommend early administration of 30 mL/kg of intravenous fluid for septic shock or sepsis-induced hypoperfusion, which may manifest as “acute organ dysfunction and/or ± decreased blood pressure and increased serum lactate.”19 Patients in modern trials of EGDT and", "score": 0.7823471 }, { "number": 12, "title": "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. - Abstract", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/15090974", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "Key recommendations, listed by category and not by hierarchy, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition; appropriate diagnostic studies to ascertain causative organisms before starting antibiotics; early administration of broad-spectrum ", "score": 0.76300776 }, { "number": 13, "title": "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. - Abstract", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/23353941", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); a", "score": 0.6852132 }, { "number": 14, "title": "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. - Abstract", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/18058085", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "Key recommendations, listed by category, include: early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures prior to antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration o", "score": 0.66699636 }, { "number": 15, "title": "Early Recognition and Initial Management of Sepsis in Adult Patients", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK598311", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "#### Affiliations\n\ncorresponding author\n\nPatient Population: Sepsis is medical emergency, associated with high morbidity and mortality, and early recognition and standardized treatment of sepsis saves lives1. This guideline is intended for adult patients.\n\nWe recommend following the Surviving Sepsis", "score": 0.62934244 }, { "number": 16, "title": "Septic Shock - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK430939", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "When sepsis-induced hypotension remains refractory to initial management with fluid resuscitation, septic shock ensues.(#article-28981.r14) Septic shock is distinguished from other shock states as a distributive type of shock. The action of a combination of inflammatory mediators (histamine, seroton", "score": 0.34973314 }, { "number": 17, "title": "Hospital Sepsis Program Core Elements - CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/sepsis/hcp/core-elements/index.html", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "| Sepsis management | Additional | Fluid resuscitation | Numerator: Hospitalizations receiving ≥30 ml/kg crystalloid fluid within 6 hours of evidence of low blood pressure and/or elevated lactate Denominator: Hospitalizations meeting criteria for sepsis, with low blood pressure (e.g., SBP<90, MAP<6", "score": 0.2588038 }, { "number": 18, "title": "Is Passive Leg Raise an Accurate Diagnostic Method for Assessing Fluid Responsiveness in Adults?", "detail": "www.annemergmed.com", "url": "https://www.annemergmed.com/article/S0196-0644(15)01513-9/pdf", "authors": "www.annemergmed.com", "host": "www.annemergmed.com", "snippet": "Passive leg raise man-euvers in the meta-analysis by Cavallaro et al 7 show how noninva-sive hemodynamic indices may be a reasonable approach in emergency department (ED) and ICU assess-ments of fl uid responsiveness and cardiac output. 8The high correlation between passive leg raise –induced cardia", "score": 0.6072213 }, { "number": 19, "title": "Outcomes Using Fluid Responsiveness to Manage Fluid Resuscitation - CHEST", "detail": "journal.chestnet.org", "url": "https://journal.chestnet.org/article/S0012-3692(21)01324-6/fulltext", "authors": "journal.chestnet.org", "host": "journal.chestnet.org", "snippet": "reported a meta-analysis on the mortality outcomes using fluid resuscitation based on fluid responsiveness compared with usual care in patients with sepsis.2. This study included four clinical trials with 365 patients, and patients with fluid resuscitation based on fluid responsiveness did not have ", "score": 0.54535896 }, { "number": 20, "title": "[PDF] Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/28/NCT03434028/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": ">20 mcg/min (0.25 mcg/kg/min in an 80 kg adult). Historically, the common practice of requiring central venous access for vasopressor infusion hampered vasopressor use early in care. However, emerging data suggest norepinephrine can be safely administered through large peripheral intravenous cathete", "score": 0.6222074 }, { "number": 21, "title": "[PDF] HCFMUSP The Effect of Non-Invasive Hemodynamic Therapy", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/57/NCT05336357/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "diagnosis; patients should receive fluid resuscitation with crystalloid solution at a rate of at least 30 ml/kg in the first 3 hours of treatment, and if after this resuscitation the SBP remains less than 90mmHg and/or MAP remains less than 65mmHg, vasoactive 5 drugs should be started; however, if a", "score": 0.5889134 }, { "number": 22, "title": "[PDF] Effects of restricting intravenous fluids vs. standard care fluid", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/36/NCT03668236/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "as indicated by the p-value. The figure is copied from . On the other hand, the types of IV fluids used vary less; crystalloid solutions are used for resuscitation in the majority of ICU patients including those with sepsis . This is in line with the strong recommendation in the SSC guideline to use", "score": 0.542161 }, { "number": 23, "title": "Fluid resuscitation management in patients with burns: update", "detail": "www.bjanaesthesia.org", "url": "https://www.bjanaesthesia.org/article/S0007-0912(17)33788-1/fulltext", "authors": "www.bjanaesthesia.org", "host": "www.bjanaesthesia.org", "snippet": "Investigate whether use of 5% albumin and vasopressors decreased fluid resuscitation-related complications and burn mortality. Albumin replacement in patients", "score": 0.47431523 }, { "number": 24, "title": "ClinicalTrials.gov AMENDED CLINICAL STUDY PROTOCOL Applicable for Sites in France only", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/48/NCT03158948/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "FOR FLUID THERAPY The following measures of fluid therapy are recommended according to the current treatment guideline of the Surviving Sepsis Campaign (9): 1. Crystalloids as the initial fluid of choice in the resuscitation of severe sepsis and septic shock 2. Against the use of hydroxyethyl starch", "score": 0.4680374 } ], "publishedAt": "2026-09-15T21:59:43.080762+00:00", "updatedAt": "2026-09-15T21:59:43.080762+00:00", "readingMinutes": 7, "slug": "sepsis-fluid-reassessment" }