From Fluid Responsiveness to Prognosis: The Emerging Role of Point-of-Care Echocardiography in Sepsis

Abstract

Sepsis is a life-threatening condition that requires early recognition and intervention to improve patient outcomes. Optimizing hemodynamic management is crucial, and clinicians must utilize all available tools to guide therapy effectively. Echocardiography is a rapid, non-invasive, and repeatable method that has emerged as a valuable tool in the management of septic patients. Studying its role can provide insights into both therapeutic guidance and prognostic assessment. The primary aim of this review is to highlight the importance of echocardiography in the hemodynamic management of patients with sepsis. The secondary objective is to assess its prognostic value, as echocardiography can inform both the immediate management of critically ill patients and their overall prognosis. A narrative review of the literature published in the last 15 years was conducted using PubMed, and references were managed with Mendeley. Articles focusing on adult and pediatric patients, as well as relevant animal studies, which evaluated echocardiographic assessment of cardiac function, fluid responsiveness, or hemodynamic management were included. Multiple studies demonstrate that echocardiography is a reliable, non-invasive, and easily repeatable tool for assessing fluid responsiveness in septic patients. It allows for dynamic monitoring of stroke volume, VTI, and other hemodynamic parameters, supporting tailored fluid and vasoactive therapy. Additionally, echocardiography provides prognostic insights, with right ventricular dysfunction emerging as a strong predictor of increased mortality. Other parameters, including global longitudinal strain and left ventricular diastolic function, further contribute to risk stratification. Echocardiography is an indispensable tool in the management of sepsis, offering both real-time guidance for hemodynamic optimization and valuable prognostic information. Its routine use can enhance personalized care and improve clinical outcomes in critically ill septic patients.

Keywords: GLS and sepsis; echocardiography and prognosis in sepsis; echocardiography and sepsis; fluid responsiveness; sepsis; stroke volume.