Abstract
<jats:p>Objective: to analyze current evidence on tissue perfusion markers and assess their role in personalized hemodynamic resuscitation during early septic shock. Material and methods. We performed an analytical review with elements of descriptive quantitative synthesis. Clinical guidelines, randomized trials, systematic reviews, meta-analyses, and major conceptual papers published in 2019–2026 and indexed in PubMed, Scopus, and Web of Science were prioritized. Results. Contemporary evidence indicates that restoration of mean arterial pressure does not necessarily imply recovery of microcirculation and organ perfusion. Capillary refill time is increasingly regarded as a rapid bedside marker of treatment response, whereas lactate should be interpreted as a contextual metabolic signal rather than an isolated resuscitation target. In ANDROMEDA-SHOCK, 28-day mortality was 34.9% versus 43.4% for capillary refill time–guided and lactate-guided strategies, respectively, while the 72-hour SOFA score was lower by 1 point in the capillary refill time group. In FRESH, dynamic fluid responsiveness assessment reduced 72-hour positive fluid balance by 1.37 L. A 2025 meta-analysis suggested that dynamic fluid responsiveness measures probably reduce 28-day mortality and the risk of acute kidney injury. Early norepinephrine initiation was associated with less fluid administration during the first 6 hours and faster achievement of the target mean arterial pressure. Conclusion. Perfusion-oriented resuscitation should integrate peripheral, metabolic, renal, and macrohemodynamic perfusion domains, whereas the most sensitive endpoints for protocol evaluation appear to be ΔSOFA72, cumulative fluid balance, duration of vasopressor support, and AKI/RRT rates.</jats:p>