INTENSIVE CARE AND RESUSCITATION: Edited by Marc LeoneHemodynamic support in septic shockGarcía-de-Acilu, Marinaa; Mesquida, Jaumeb; Gruartmoner, Guillemb; Ferrer, RicardaAuthor Information aIntensive Care Department, Hospital Universitari Vall d’Hebron, Barcelona bCritical Care Department, Parc Taulí Hospital Universitari, Sabadell, Spain Correspondence to Ricard Ferrer, MD, PhD, Intensive Care Department, Vall d’Hebron University Hospital, P. Vall d’Hebron 119-129, 08035 Barcelona, Spain. Tel: +34 93 274 62 09; e-mail: [email protected] Current Opinion in Anaesthesiology: April 2021 - Volume 34 - Issue 2 - p 99-106 doi: 10.1097/ACO.0000000000000959 Buy Metrics Abstract Purpose of review The current article reviews recent findings on the monitoring and hemodynamic support of septic shock patients. Recent findings The ultimate goal of hemodynamic resuscitation is to restore tissue oxygenation. A multimodal approach combining global and regional markers of tissue hypoxia seems appropriate to guide resuscitation. Several multicenter clinical trials have provided evidence against an aggressive fluid resuscitation strategy. Fluid administration should be personalized and based on the evidence of fluid responsiveness. Dynamic indices have proven to be highly predictive of responsiveness. Recent data suggest that balanced crystalloids may be associated with less renal failure. When fluid therapy is insufficient, a multimode approach with different types of vasopressors has been suggested as an initial approach. Dobutamine remains the firs inotropic option in patients with persistent hypotension and decrease ventricular systolic function. Calcium sensitizer and phosphodiesterase inhibitors may be considered, but evidence is still limited. Veno-arterial extracorporeal membrane oxygenation may be considered in selected unresponsive patients, particularly with myocardial depression, and in a highly experienced center. Summary Resuscitation should be personalized and based on global and regional markers of tissue hypoxia as well as the fluid responsiveness indices. The beneficial effect of multimode approach with different types of vasopressors, remains to be determined. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.