Septic shock in the postoperative patient: three important management decisions.

The medical consultant should have a high index of suspicion for sepsis. Early goal-directed therapy is recommended and includes early, aggressive fluid resuscitation, antibiotics, and vasoactive agents, if needed. CVO2 may be helpful in guiding therapy, but targeting supranormal levels of oxygen delivery is not necessary. Empiric use of steroids and early use of activated protein C also need to be considered. Vasopressin should be considered if hypotension persists or if the situation requires escalating doses of norepinephrine.