Hemodynamic resuscitation in septic shock: cardiovascular support and adjunctive therapy

Sepsis is associated with hemodynamic derangements that lead to tissue hypoperfusion and multisystem organ failure if uncorrected. Considerable data published in recent years have addressed detection and treatment of sepsis. However, much is unknown about the selection and titration of appropriate therapy, appropriate goals and end points for resuscitation, and the hemodynamic monitoring necessary based on these goals and end points. Current therapeutic interventions include preload optimization, initiation of timely and appropriate vasopressor and inotropic support, decisions about corticosteroid therapy and recombinant human activated protein C, and early and adequate antibiotic therapy. This article focuses on the cardiovascular support of the septic shock patient, and the current evidence to guide decisions on the use of corticosteroid therapy and recombinant human activated protein C.