An attempt to identify the primary site of infection should be made upon diagnosis of this condition. If the source of infection is amenable to surgical control, this should be carried out expeditiously as soon as the patient's condition is sufficiently stable. Broad spectrum antibiotic therapy is initiated and based upon likely infectious organisms. A typical treatment regimen consists of triple antibiotics, such as ampicillin, gentamicin, and clindamycin. Repletion of the intravascular volume with a physiologic crystalloid solution is generally recommended.
Some authors advocate infusion of colioid-containing fluid to replace intravascular volume deficits.
Since an increase in pulmonary capillary permeability accompanies septic shock, attempts to replete volume with colloidcontaining fluid in this condition may result in a detrimental increase in extravascular pulmonary water. Fluid therapy is best managed with the use of Swan-Ganz catheter monitoring of pulmonary artery wedge pressures and cardiac output. Insertion of a Foley catheter for measurement of the hourly urine output is also necessary. Many patients with sepsis and shock will develop pulmonary insufficiency necessitating endotracheal intubation and assisted ventilation. Inadequate tissue oxygenation is a consistent factor in shock, and therefore efforts to maintain a normal oxygen hemoglobin dissociation curve should be undertaken.