The cardiovascular effects of sepsis.

Future therapies for septic shock will likely center around the antagonism of toxins released by the infecting organism and the modification of the host response to such toxins. Until such therapies become available, patient salvage will continue to depend on the maintenance of effective circulatory function until the source of infection is eliminated. With the recognition that resuscitation is best directed toward optimization of peripheral oxygen metabolism, reduction of mortality has been achieved in recent years through the early application of invasive hemodynamic monitoring and the aggressive manipulation of the determinants of peripheral oxygen delivery. Volume loading to improve myocardial performance, transfusion to increase the oxygen carrying capacity of the blood, intubation and mechanical ventilation to maximize arterial oxygen saturation, sedation to limit unnecessary peripheral oxygen use, and pharmacologic support of supranormal peripheral perfusion requirements are the essential tenets of successful management.