ABSTRACT
Vasoactive agents are commonly required in the management of septic shock not only
to restore a sufficient tissue perfusion pressure but also to increase blood flow
and oxygen delivery to the organs. Importantly, vasoactive agents are no substitute
for fluid therapy. Defining end points for therapy remains difficult. These should
be, above all, clinical. Even though the gut may play an important role in the development
of multiple organ failure, the use of gastric tonometry to guide therapy cannot be
recommended at this time. Study of the microcirculation at the bedside with orthogonal
polarization spectral imaging may be helpful in the future. Adrenergic agents are
the preferred agents for hemodynamic stabilization. Dopamine and norepinephrine are
the drugs of choice to increase arterial pressure. Dobutamine remains the agent of
choice to increase blood flow to the organs, including the gut and the kidneys. Many
questions remain unanswered with respect to optimal hemodynamic management of septic
shock.
KEYWORD
Splanchnic circulation - gastric tonometry - adrenergic agents - circulatory shock
- multiple organ failure
