Should We Do an Individual Management of Septic Shock in Neurocritically Ill Patients? A Proposal of a Conceptual Algorithm.

Septic shock (SS) constitutes a complex and potentially severe entity associated with a high mortality rate worldwide.The neurocritically ill patient represents a vulnerable population with a marked tendency to develop SS . In turn, invasive neuromonitoring devices-such as external ventricular drainage (EVD)-may predispose to intracranial infections, which in some cases may progress to SS . Early goal-directed therapy (EGDT) was initially proposed by Rivers et al. for the management of SS. However, lately its application has been discussed due to its higher hospitalization costs and excessive heterogeneity among patients in the baseline inflammation levels and stage of organ dysfunction . Thus, the strategy for addressing these scenarios more effectively might be an individualized approach. To solve this research question, we proposed a novel conceptual algorithm to approach neurocritically ill patients with SS to improve the DO2/VO2 ratio and neurological outcome by optimizing the mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) among other hemodynamic and neurocritical parameters.