Evaluation of Evidence, Pharmacology, and Interplay of Fluid Resuscitation and Vasoactive Therapy in Sepsis and Septic Shock

We sought to review the pharmacology of vasoactive therapy and fluid administration in sepsis and septic shock, with specific insight into the physiologic interplay of these agents. A PubMed/MEDLINE search was conducted using the following terms (vasopressor OR vasoactive OR inotrope) AND (crystalloid OR colloid OR fluid) AND (sepsis) AND (shock OR septic shock) from 1965 to October 2020. A total of 1,022 citations were reviewed with only relevant clinical data extracted. While physiologic rationale provides a hypothetical foundation for interaction between fluid and vasopressor administration, few studies have sought to evaluate the clinical impact of this synergy. Current guidelines are not in alignment with the data available, which suggests a potential benefit from low-dose fluid administration and early vasopressor exposure. Future data must account for the impact of both of these pharmacotherapies when assessing clinical outcomes and should assess personalization of therapy based on the possible interaction.

Automated summary

The review examined the pharmacology of vasoactive therapy and fluid administration in sepsis and septic shock, highlighting the physiologic interplay between these agents. While there is physiological rationale for potential synergy between fluid and vasopressor administration, few clinical studies have evaluated the impact of this interaction. Current guidelines do not align with available data, suggesting a potential benefit from low-dose fluid administration and early vasopressor exposure, indicating a need for further research to assess personalized therapy based on this interaction.