Patients with sepsis induced hypoperfusion or shock

Initial Fluid Resuscitation in Sepsis-Induced Hypoperfusion or Shock:
Patients with sepsis-induced hypoperfusion or shock require at least 30 mL/kg of IV crystalloid fluids within the first 3 hours of resuscitation. This is a critical step in stabilizing the patient and restoring perfusion.

Guiding Further Resuscitation:
After initial fluid administration, further resuscitation can be guided by:

• Serum lactate levels: To assess tissue perfusion and response to treatment.
• Cardiac output or stroke volume assessments: For more precise hemodynamic monitoring.

In resource-limited settings, pulse pressure variation (PPV) can be a useful tool. A greater than 15% increase in pulse pressure during a passive leg raise test (held for 60–90 seconds) indicates that the patient is fluid-responsive.

Choice of Crystalloid Solutions:
Balanced crystalloid solutions (e.g., Plasma-Lyte) are preferred over normal saline. This is because balanced crystalloids are associated with:

• Fewer adverse events, such as hyperchloremic metabolic acidosis.
• Reduced need for vasopressors due to better physiological compatibility.