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Resuscitation is a cornerstone of management. This review covers five areas of evolving practice in the management of early sepsis-induced hypoperfusion: fluid resuscitation volume, timing of vasopressor initiation, resuscitation targets, route of vasopressor administration, and use of invasive blood pressure monitoring. For each topic, we review the seminal evidence, discuss the evolution of practice over time, and highlight questions for additional research. Intravenous fluids are a core component of early sepsis resuscitation. However, with growing concerns about the harms of fluid, practice is evolving toward smaller-volume resuscitation, which is often paired with earlier vasopressor initiation. Large trials of fluid-restrictive, vasopressor-early strategies are providing more information about the safety and potential benefit of these approaches. Lowering blood pressure targets is a means to prevent fluid overload and reduce exposure to vasopressors; mean arterial pressure targets of 60\u201365 mm Hg appear to be safe, at least in older patients. With the trend toward earlier vasopressor initiation, the need for central administration of vasopressors has been questioned, and peripheral vasopressor use is increasing, although it is not universally accepted. Similarly, although guidelines suggest the use of invasive blood pressure monitoring with arterial catheters in patients receiving vasopressors, blood pressure cuffs are less invasive and often sufficient. Overall, the management of early sepsis-induced hypoperfusion is evolving toward fluid-sparing and less-invasive strategies. However, many questions remain, and additional data are needed to further optimize our approach to resuscitation.<\/jats:p>","DOI":"10.1164\/rccm.202209-1831ci","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T17:09:40Z","timestamp":1677085780000},"page":"1283-1299","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":40,"title":["Evolving Management Practices for Early Sepsis-induced Hypoperfusion: A Narrative Review"],"prefix":"10.1093","volume":"207","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3353-612X","authenticated-orcid":false,"given":"Elizabeth S.","family":"Munroe","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1890-4932","authenticated-orcid":false,"given":"Robert C.","family":"Hyzy","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7664-8263","authenticated-orcid":false,"given":"Matthew W.","family":"Semler","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5338-2538","authenticated-orcid":false,"given":"Manu","family":"Shankar-Hari","sequence":"additional","affiliation":[{"name":"Centre for Inflammation Research, The University of Edinburgh, Edinburgh, United Kingdom"},{"name":"Department of Intensive Care Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3428-3083","authenticated-orcid":false,"given":"Paul J.","family":"Young","sequence":"additional","affiliation":[{"name":"Medical Research Institute of New Zealand, Wellington, New Zealand"},{"name":"Intensive Care Unit, Wellington Hospital, Wellington, New Zealand"},{"name":"Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia"},{"name":"Department of Critical Care, University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9315-6386","authenticated-orcid":false,"given":"Fernando G.","family":"Zampieri","sequence":"additional","affiliation":[{"name":"Hospital do Cora\u00e7\u00e3o (HCor) Research Institute, S\u00e3o Paulo, Brazil"},{"name":"Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, 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