The standard treatment approach has not changed appreciably in the past two decades. 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.