[Symptomatic treatment of septic shock]

Septic shock is characterized by an important vasoplegia associated with an oxygen extraction abnormality probably linked to the presence of a biochemical alteration at the microcirculatory level. Hemodynamic intervention requires aggressive fluid resuscitation complemented if necessary by the use of sympathomimetic amines (dopamine and often epinephrine, norepinephrine). Dobutamine is indicated when left ventricular dysfunction was obviously demonstrated. Swan Ganz catheter is required when hemodynamic intervention -ie fluid resuscitation and dopamine-remains unefficacious. However the earlier indication of Swan Ganz catheter use might be justified by the necessity of a precise preload evaluation and the possibility of the determination of the best oxygen transport.