Myocardial and Circulatory Compromise in Adult and Pediatric Sepsis: New Perspectives Highlighting the Importance of Goal-Directed Interventions Based on Advanced Hemodynamic Monitoring

Sepsis is a complex infection-driven inflammatory syndrome that can lead to life-threatening multi-organ failure and septic shock, characterized by cardiovascular instability, tissue hypoperfusion, and impaired oxygen utilization. Myocardial dys-function is a frequent and multifaceted complication in both adults and children, with sepsis-induced cardiomyopathy (SCM) representing an acute, reversible form of non-ischemic cardiac failure involving left and sometimes right ventricular impairment. Diagnosis relies on excluding acute coronary syndromes and recognizing refractory shock, low mixed venous oxygen saturation, and elevated cardiac biomarkers, espe-cially in patients with known risk factors such as pre-existing heart disease or elevated lactate. The pathophysiology reflects an interplay of systemic inflammation, circulatory redistribution, and mitochondrial dysfunction, while clinical recognition remains challenging, particularly in pediatrics where hypotension is a late sign. Early fluid re-suscitation is vital to restore perfusion, yet excessive administration risks fluid overload, underscoring the need for precise hemodynamic assessment. Conventional echocar-diographic measures of heart function may give misleading results in SCM because they depend on preload and afterload, often underestimating the true degree of myocardial impairment. Advanced hemodynamic monitoring, ranging from invasive to minimally invasive and non-invasive methods, is currently being studied for managing sepsis. Minimally invasive techniques offer detailed, dynamic data that complement echocar-diography and help identify specific hemodynamic profiles to guide septic shock treatment. Contemporary management increasingly favors multimodal monitoring and individualized strategies over protocol-driven approaches to optimize timely, goal-directed therapy.