Less-Invasive Hemodynamic and Tissue Perfusion Monitoring in Sepsis and Septic Shock: A Narrative Review.

Sepsis and septic shock remain major causes of morbidity and mortality in critically ill patients. Hemodynamic management is a cornerstone of treatment, yet the optimal monitoring strategy to guide resuscitation is still debated. The progressive decline in the use of invasive techniques, such as pulmonary artery catheterization, has favored the development of less-invasive and non-invasive monitoring approaches. Recent technologies allow continuous assessment of cardiovascular function through arterial waveform analysis, non-invasive blood pressure monitoring, and predictive algorithms, while increasing attention has been directed toward the evaluation of tissue perfusion and oxygenation. This reflects the recognition that normalization of macrocirculatory variables does not necessarily ensure adequate microcirculatory perfusion in sepsis. This narrative review summarizes current evidence on less-invasive hemodynamic and tissue perfusion monitoring in sepsis and septic shock, discussing their physiological rationale and potential role within contemporary, multimodal resuscitation strategies.