There is more to septic shock than arterial hypotension and elevated lactate levels: another appeal to rethink current resuscitation strategies!

Excerpt

Sepsis is an umbrella syndrome created by clinicians to identify patients with an acute infection and a high risk of death. The Sepsis-3 definition group recognized new organ dysfunction as the key indicator determining whether a patient falls into the group with a high risk of death or not [1]. The same group has redefined septic shock as the combined presence of arterial hypotension [arbitrarily described by a mean arterial pressure (MAP) of 65 mmHg or less] and elevated lactate levels in the absence of hypovolemia [1]. Patients fulfilling these criteria were found to have a higher mortality compared to those presenting with sepsis alone [1, 2]. Despite of having an increased risk of death in common, patients with sepsis or septic shock represent a heterogeneous group of critically ill patients with different genotypes, comorbidities, underlying infections, clinical presentations (phenotypes), treatment requirements, and prognoses. Taking this into account, it is highly unlikely that standard treatment approaches, such as vasopressor therapy, are uniformly beneficial for all septic patients presenting with arterial hypotension and elevated lactate levels. So far, merely few studies have addressed this clinical and therapeutic heterogeneity of patients with sepsis or septic shock [3‐5]. It is only the failure of (large) clinical trials to identify single therapies that improve survival [6] which reminds us about the fact that patients with sepsis share an increased risk of death but not the need for uniform treatment. …