Table 4 Hemodynamics in early septic shock

Which MAP targets to stabilize the macrocirculation?

MAP ≥ 65 mmHg

What is the best timing for MAP intervention in sepsis? and until when?

Could “permissive hypotension” be considered as in the case of trauma? for which reason(s) and target(s)?

How much fluid resuscitation and when?

From “time of presentation” or “time zero,” 30 mL/kg at least within 1 h

Should we prioritize fixed minimum fluid resuscitation or dynamic personalized reassessment of circulation status?

Which fluid(s)?

Crystalloids

Beyond balanced versus unbalanced crystalloid fluid selection, should we prefer acetate- or lactate-buffered solutions?

How long?

After the initial 1-h interventions, further fluid administration needs patients’ assessment for responsiveness

What “gauge for a filled tank”?

Which vasoactive (± inotropic) drug(s)?

NE is recommended as a 1st choice vasopressor. AVP or E can be added to help reaching the target (i.e., MAP) and spare NE

Within a “hour-1 bundle” strategy, should we trade-off less fluids and more vasoactive drugs to vice versa?

When?

Dobutamine only if target not reached after adequate fluid loading and use of vasoactive drugs

Are vasopressor combinations able to reach high MAP levels without detrimental cardiac side effects?

As early as during the initial fluid resuscitation period, to achieve the target MAP ≥ 65 mmHg ASAP

With NE as the currently recommended first-line vasopressor is “decatecholaminization” feasible and safe?