Treatment of septic shock.

Septic shock can result from infections with either gram-positive or gram-negative bacteria, and is defined by a systolic blood pressure value of less than 90 mm Hg or by a fall of more than 50 mm Hg in the systolic pressure of a previously hypertensive individual. Treatment of septic shock has 2 objectives. The first is to control the initiating infectious process primarily with antibiotics, which includes a combination of one with a gram-positive spectrum that includes Staphylococcus aureus, as well as one with a broad, gram-negative spectrum that is effective against enterobacteriacae and pseudomonas, for example, an aminoglycoside. If an abdominal or pelvic source is suspected because of recent abdominal surgery or physical findings, an antibiotic effective against Bacterioides fragilis should be added. The author sets out principles to serve as a guide for antibiotic administration. The second objective is to normalize the patient's hemodynamic state by pressor agents or volume expansion, options which the author describes also. In addition, he explains that the use of corticosteroids in septic shock remains controversial and that the use of heparin may be counterproductive.