{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:28:52Z","timestamp":1791415732063,"version":"4.3.3"},"reference-count":205,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T00:00:00Z","timestamp":1706918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Sepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; however, there are aspects that have changed. This narrative review highlights current and avant-garde methods of handling patients experiencing septic shock based on the experience of its authors and the best available evidence in a context of uncertainty. Following the first recommendation of the Surviving Sepsis Campaign guidelines, it is recommended that specific sepsis care performance improvement programs are implemented in hospitals, i.e., \u201cSepsis Code\u201d programs, designed ad hoc, to achieve this goal. Regarding hemodynamics, the importance of perfusion and hemodynamic coherence stand out, which allow for the recognition of different phenotypes, determination of the ideal time for commencing vasopressor treatment, and the appropriate fluid therapy dosage. At present, this is not only important for the initial timing, but also for de-resuscitation, which involves the early weaning of support therapies, directed elimination of fluids, and fluid tolerance concept. Finally, regarding blood purification therapies, those aimed at eliminating endotoxins and cytokines are attractive in the early management of patients in septic shock.<\/jats:p>","DOI":"10.3390\/jpm14020176","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T03:28:29Z","timestamp":1707103709000},"page":"176","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3045-4890","authenticated-orcid":false,"given":"Fernando","family":"Ramasco","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de Le\u00f3n 62, 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Nieves-Alonso","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de Le\u00f3n 62, 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Garc\u00eda-Villabona","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de Le\u00f3n 62, 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Vallejo","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de Le\u00f3n 62, 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1997-6893","authenticated-orcid":false,"given":"Eduardo","family":"Kattan","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Intensiva del Adulto, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, Marcoleta 367, Santiago 8320000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"M\u00e9ndez","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Surgical Intensive Care, Hospital Universitario de La Princesa, Diego de Le\u00f3n 62, 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s00134-019-05544-x","article-title":"Challenges in the management of septic shock: A narrative review","volume":"45","author":"Cecconi","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e10128","DOI":"10.15252\/emmm.201810128","article-title":"Sepsis therapies: Learning from 30 years of failure of translational research to propose new leads","volume":"12","author":"Cavaillon","year":"2020","journal-title":"EMBO Mol. 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