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Clinical Management of Endotoxemia: Volume Support

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Endotoxin Induced-Shock: a Multidisciplinary Approach in Critical Care

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Abstract

The inflammatory storm, as well as the direct effect of endotoxins on endothelium, may induce hemodynamic instability. Targeted fluid replacement plays a key role in endotoxic shock, with the aim of balancing resuscitation thus avoiding additional harm. Many types of solutions are available for fluid administration. Currently, some study groups promote the use of intravenous balanced solutions whilst chloride administration may impact on renal function even at low doses by causing both tubular dysfunction and arteriolar vasoconstriction. Synthetic colloids usage is contraindicated. There is still a controversial role of albumin; SSC2021 guidelines suggest administering albumin to avoid the infusion of an exaggerated volume of crystalloids to restore hemodynamic stability (weak recommendation, low quality of evidence). The hemodynamic effects and the reliability of these dynamic indices of fluid responsiveness are well described in literature. Further research on this topic is warranted, to avoid crossing the threshold between active management and noxious actions, a daily challenge in critical care medicine.

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Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

    Marzia Savi & Massimiliano Greco

  2. Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

    Marzia Savi & Massimiliano Greco

  3. Cardiothoracic Department, Division of Cardiothoracic Intensive Care, ASST Spedali Civili, Brescia, Italy

    Andrea Montisci

Authors
  1. Marzia Savi
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  2. Andrea Montisci
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  3. Massimiliano Greco
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Corresponding author

Correspondence to Massimiliano Greco .

Editor information

Editors and Affiliations

  1. Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Centre for Medical Sciences - CISMed University of Trento, Via S. Maria Maddalena, Trento, Italy

    Silvia De Rosa

  2. Anesthesiology and Intensive Care, Dept. of Health Science, University of Florence, Firenze, Italy

    Gianluca Villa

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Savi, M., Montisci, A., Greco, M. (2023). Clinical Management of Endotoxemia: Volume Support. In: De Rosa, S., Villa, G. (eds) Endotoxin Induced-Shock: a Multidisciplinary Approach in Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-031-18591-5_7

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  • DOI: https://doi.org/10.1007/978-3-031-18591-5_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-18590-8

  • Online ISBN: 978-3-031-18591-5

  • eBook Packages: MedicineMedicine (R0)

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