Paradigm shift in emergency management of septic cardiomyopathy: from fluid resuscitation to metabolic resuscitation

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Meng C and Sun J conducted searches of the scientific literature and developed the draft of the manuscript. Miao G provided contributions to the conception and design of the study, in addition to revising the manuscript with a focus on critical intellectual content. All authors reviewed and approved the final version of the manuscript.

Funding

This study was supported by the National Key R&D Program of China (2023YFC3011904).

Ethical approval of studies and informed consent

Not applicable.

Acknowledgements

None.

References

[1] L’Heureux ML, Sternberg M, Brath L, Turlington J, Kashiouris MG . Sepsis-induced cardiomyopathy: a comprehensive review. Curr Cardiol Rep. 2020; 22(5): 35. doi: 10.1007/s11886-020-01277-2.

[2] Ladzinski AT, Thind GS, Siuba MT . Rational fluid resuscitation in sepsis for the hospitalist: a narrative review. Mayo Clin Proc. 2021; 96(9): 2464-2473. doi: 10.1016/j.mayocp.2021.05.020.

[3] Tan L, She H, Zheng J, et al. Effects of Malate Ringer’s solution on myocardial injury in sepsis and enforcement effects of TPP@PAMAM-MR. J Transl Med. 2022; 20(1): 591. doi: 10.1186/s12967-022-03811-y.

[4] Nuyttens L, Heyerick M, Heremans G, et al. Unraveling mitochondrial pyruvate dysfunction to mitigate hyperlactatemia and lethality in sepsis. Cell Rep. 2025; 44(8): 116032. doi: 10.1016/j.celrep.2025.116032.

[5] Fan Y, Guan B, Xu J, Zhang H, Yi L, Yang Z . Role of toll-like receptor-mediated pyroptosis in sepsis-induced cardiomyopathy. Biomed Pharmacother. 2023; 167: 115493. doi: 10.1016/j.biopha.2023.115493.

[6] Beesley SJ, Sorensen J, Walkey AJ, et al. Long-term implications of abnormal left ventricular strain during sepsis. Crit Care Med. 2021; 49(4): e444-e453. doi: 10.1097/CCM.0000000000004886.

[7] Ji L, He Q, Liu Y, et al. Ketone body β-hydroxybutyrate prevents myocardial oxidative stress in septic cardiomyopathy. Oxid Med Cell Longev. 2022; 2022: 2513837. doi: 10.1155/2022/2513837.

[8] Taha AM, Mahmoud AM, Ghonaim MM, et al. Melatonin as a potential treatment for septic cardiomyopathy. Biomed Pharmacother. 2023; 166: 115305. doi: 10.1016/j.biopha.2023.115305.

[9] Corl KA, Levy MM, Holder AL, Douglas IS, Linde-Zwirble WT, Alam A . Moderate IV fluid resuscitation is associated with decreased sepsis mortality. Crit Care Med. 2024; 52(11): e557-e567. doi: 10.1097/CCM.0000000000006394.