Inotrope/vasopressor support in sepsis-induced organ hypoperfusion

Vasoactive agents are commonly required in the management of septic shock n ot only to restore a sufficient tissue perfusion pressure but also to incre ase blood flow and oxygen delivery to the organs. Importantly, vasoactive a gents are no substitute for fluid therapy. Defining end points for therapy remains difficult. These should be, above all, clinical. Even though the gu t 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 polariz ation spectral imaging may be helpful in the future. Adrenergic agents are the preferred agents for hemodynamic stabilization. Dopamine and norepineph rine are the drugs of choice to increase arterial pressure. Dobutamine rema ins the agent of choice to increase blood flow to the organs, including the gut and the kidneys. Many questions remain unanswered with respect to opti mal hemodynamic management of septic shock.