Septic shock.

PURPOSE OF REVIEW: This review aims to provide a summary of recent updates in resuscitation and vasopressor strategies for septic shock, as well as advancements in precision therapy.

RECENT FINDINGS: Septic shock results from a dysregulated host response to infection and remains a significant cause of global morbidity and mortality. While standard care of septic shock remains protocolized due to improved outcomes with timely antibiotic and fluid administration, recent data have informed a more nuanced, individualized approach to sepsis management. Increasing evidence suggests that septic shock results from dynamic phases of immune dysregulation that may provide targets for precision therapy and data from large clinical trials have informed a complementary approach to fluid and vasopressor administration, rather than a fixed, fluid-centric approach. Results additionally suggest improved outcomes with integration of multimodal perfusion targets, as well as an individualized approach to invasive hemodynamic monitoring and endpoints of resuscitation, such as capillary refill time and mean arterial perfusion pressure targets.

SUMMARY: Recent clinical trial data have enhanced physiology-driven septic shock management and demonstrated improved outcomes. Future studies will aim to further understanding of individual sepsis phenotypes and use of precision therapies.