Emerging concepts in the care of patients with cirrhosis and septic shock

Figure 1 Hemodynamic considerations in the management of cirrhosis and septic shock. A: Left; Normal mean systemic filling pressures (MSFP) leading to adequate venous return and cardiac output (CO). Middle; vasodilation in cirrhosis leading to lower MSFP and inadequate venous return (VR). However, compensatory mechanisms are able to maintain adequate CO. Right; further vasodilation leading to lower MSFP and inadequate VR. In this case, neurohumoral and cardiac compensation are not enough to maintain CO; B: Left; cirrhosis and septic shock pathophysiology. Middle; Effects of adequate volume resuscitation leading to increased MSFP. In the context of normal filling pressures, this will increase VR and CO. Right; Excessive fluid resuscitation will lead to high filling pressures which will decrease VR and CO. In addition, it may lead to volume overload and capillary leak; C: Left; cirrhosis and septic shock pathophysiology. Right; adjuvant effect of fluids and vasopressors on MSFP, VR and CO without leading to volume overload. CO: Cardiac output; MSFP: Mean systemic filling pressures; RA: Right atrium; VR: Venous return.