Vasoactive agents are commonly required in the management of septic shock not only to restore a sufficient tissue perfusion pressure but also to increase blood flow and oxygen delivery to the organs. Importantly, vasoactive agents are no substitute for fluid therapy. Defining end points for therapy remains difficult. These should be, above all, clinical. Even though the gut 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 polarization spectral imaging may be helpful in the future. Adrenergic agents are the preferred agents for hemodynamic stabilization. Dopamine and norepinephrine are the drugs of choice to increase arterial pressure. Dobutamine remains the agent of choice to increase blood flow to the organs, including the gut and the kidneys. Many questions remain unanswered with respect to optimal hemodynamic management of septic shock.
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