Table 1 The Surviving Sepsis Campaign protocol for the initial hemodynamic resuscitation in severe sepsis and septic shock (adopted from [10])

Begin resuscitation immediately in patients with hypotension or elevated serum lactate of greater than 4 mmol/L, using either crystalloids or colloids. Give fluid challenges of 1,000 mL of crystalloids or 300 to 500 mL of colloids over the course of 30 minutes. More rapid and larger volumes may be required in sepsis-induced tissue hypoperfusion.

Resuscitation goals include the following:

   Central venous pressure (CVP) of 8 to 12 mm Hg. A higher target CVP of 12 to 15 mm Hg is recommended in the presence of mechanical ventilation or pre-existing decreased ventricular compliance.

   Mean arterial pressure of greater than or equal to 65 mm Hg

   Urine output of greater than or equal to 0.5 mL/kg per hour

   Central venous (superior vena cava) oxygen saturation (ScvO₂) of greater than or equal to 70% or mixed venous oxygen saturation (SvO₂) of greater than or equal to 65%.

If venous O₂ saturation target is not achieved, consider further fluid, transfuse packed red blood cells if required to hematocrit of greater than or equal to 30%, and/or start dobutamine infusion.