Patients with the sepsis syndrome should be volume resuscitated. Most patients with sepsis are intravascularly depleted and require infusion of significant amounts of fluid. This fluid should not be infused through a pump, as even the fastest rates delivered by a pump are not adequate. Rather, the fluid should be delivered using the shortest tubing available through a central venous catheter or a large bore peripheral catheter. The most commonly used agents with alpha adrenergic activity are dopamine, norepinephrine, and phenylephrine.
Norepinephrine has more alpha than beta-adrenergic activity.
There are few studies to support the use of one vasopressor agent over another. Norepinephrine may be more effective than dopamine at reaching therapeutic endpoints if adequate fluid resuscitation has been given. The aim of volume resuscitation and pressor agent therapy is to maintain adequate organ perfusion and delivery of oxygen to the tissues. Vasopressors are commonly titrated to a mean arterial pressure of 60. Higher mean arterial pressures may be required in a patient with baseline hypertension, and alternate clinical means of assessing organ perfusion such as those listed above may be helpful in such patients.