# Less-Invasive Hemodynamic and Tissue Perfusion Monitoring in Sepsis and Septic Shock: A Narrative Review

## TL;DR

This paper reviews less-invasive methods for monitoring blood flow and tissue health in sepsis patients, highlighting their role in improving treatment strategies.

## Contribution

The paper provides a comprehensive overview of emerging less-invasive monitoring technologies for sepsis, emphasizing their physiological relevance and clinical utility.

## Key findings

- Invasive monitoring techniques like pulmonary artery catheterization are being replaced by less-invasive alternatives.
- New technologies focus on continuous cardiovascular assessment and tissue oxygenation to improve sepsis management.
- Normalization of large blood vessel parameters may not reflect adequate small blood vessel perfusion in sepsis.

## Abstract

Sepsis and septic shock remain major causes of morbidity and mortality in critically ill patients. Hemodynamic management is a cornerstone of treatment, yet the optimal monitoring strategy to guide resuscitation is still debated. The progressive decline in the use of invasive techniques, such as pulmonary artery catheterization, has favored the development of less-invasive and non-invasive monitoring approaches. Recent technologies allow continuous assessment of cardiovascular function through arterial waveform analysis, non-invasive blood pressure monitoring, and predictive algorithms, while increasing attention has been directed toward the evaluation of tissue perfusion and oxygenation. This reflects the recognition that normalization of macrocirculatory variables does not necessarily ensure adequate microcirculatory perfusion in sepsis. This narrative review summarizes current evidence on less-invasive hemodynamic and tissue perfusion monitoring in sepsis and septic shock, discussing their physiological rationale and potential role within contemporary, multimodal resuscitation strategies.