Hemodynamic Guidelines from the Surviving Sepsis Campaign: Where Do we Stand Today?

Abstract

Introduction: Two years after the last Surviving Sepsis Campaign (SSC) guidelines, we reviewed initial hemodynamic support in septic shock.

Material and methods: Last SSC guidelines for hemodynamic goals and initial treatment in septic shock were discussed in light of the latest publications.

Results: Hemodynamic status during volemic expansion could be better evaluated. However at this time, guideline modifications cannot be supported in the absence of sufficiently robust studies. A minimal mean arterial pressure target of 65 mmHg seems to be suitable for general population, but a higher threshold [80-85 mmHg] can be proposed for patients with chronic hypertension. Hemoglobin target for transfusion of 7 to 9 g/dL in the SSC guidelines, could be decreased to 7 g/dL.

Conclusion: Although some points could be updated, current data in the literature do not support important SSC guideline modifications. The real impact of these recommendations remains difficult to assess.