Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine.

OBJECTIVE: To present guidelines for hemodynamic support of adult patients with sepsis. PARTICIPANTS: An international task force of nine experts in disciplines related to critical care medicine was convened from the membership of the Society of Critical Care Medicine. EVIDENCE: Review of published literature and expertise and personal experience of task force. The strength of evidence of human studies was classified according to study design and scientific value. CONSENSUS PROCESS: The task force met several times in person and communicated by electronic mail to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the experts'opinions. Draft documents were composed and debated by the task force until consensus was reached. The strength of recommendations was graded according to evidenced-based guidelines.
CONCLUSIONS: The panel formulated an underlying approach to the hemodynamic support of sepsis. Hemodynamic therapies should be titrated to specific and definable endpoints. The effects of therapy should be assessed by monitoring a combination of parameters of global and regional perfusion. Using this approach, the panel made specific recommendations for fluid resuscitation, vasopressor therapy, and inotropic therapy of septic patients.