Beyond Mean Arterial Pressure and Lactate: Perfusion End Points for Managing the Shocked Patient

Abstract

Patients in shock present frequently to the emergency department. The emergency physician must be skilled in the resuscitation of both differentiated and undifferentiated shock. Early, aggressive resuscitation of patients in shock is essential, using macrocirculatory, microcirculatory, and clinical end points to guide interventions. Therapy should focus on the restoration of oxygen delivery to match tissue demand. This article reviews the evidence supporting common end points of resuscitation for common etiologies of shock and limitations to their use.

Keywords: Capillary refill time; Cardiogenic shock; Critical care; Lactate; Resuscitation; Resuscitation end points; Sepsis.