Nonetheless, modest improvements in outcome have accrued as the result of improved nutrition and supportive care and skillful use of vasopressor agents. The key determinant in survival is early recognition of sepsis and initiation of treatment while the process is readily reversible. This requires constant vigilance by the clinician caring for patients with a variety of medical and surgical illnesses. Fluid resuscitation is a mandatory first step in the treatment of septic shock. The diffuse vascular leak that occurs in septic shock necessitates provision of adequate circulating blood volume to maintain tissue perfusion.
Debate continues regarding the appropriateness of colloid versus crystalloid fluids.
The optimal amount of fluid therapy for patients in septic shock remains a source of controversy. A delicate balance is required between maintenance of tissue perfusion and prevention of fluid overload, with its attendant risk of lung injury. Maintenance of a pulmonary arterial occlusion pressure of approximately 12 mm Hg is considered a reasonable starting point in patients who have hemodynamic monitors in place. When patients fail to improve hemodynamically with fluids alone, vasopressor agents are often used to reestablish systemic arterial blood pressure. Dopamine has been the vasopressor agent of choice for the past two decades because of its presumed favorable effects on renal vasodilatation and its modest inotropic effects.