The use of vasoactive drugs in severe sepsis should only follow adequate fluid resuscitation and this usually requires more extensive monitoring than can be done in an ordinary ward. In the ICU, therapeutic strategies are aimed at normalising as far as possible the global, regional, and microcirculatory defects in oxygen transport that occur in severe sepsis. These strategies are guided by the more explicit measurements of cardiac output and SVR. The effects of different vasoactive drugs on the microcirculation are also considered. Intubation and ventilation is an important part of the strategy to improve oxygen delivery (DO2) and reduce uptake (VO2). Early referral to iCu should be considered in all patients with severe sepsis.
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