Patient selection: hypotension or lactic acidosis
Time period for initial resuscitation: first 6 hours
Initial resuscitation starts with intravenous fluid infusion and the starting of intravenous antibiotic therapy.
The goal of initial resuscitation involves all of the following:
(1) central venous pressure 8 to 12 mm Hg
(2) mean arterial pressure >= 65 mm Hg
(3) urine output >= 0.5 mL per kg per hour
(4) central venous oxygen saturation >= 70%
If these goals are not achieved then the next steps include:
(1) achieve a hematocrit >= 30% by red blood cell transfusion
(2) start a dobutamine infusion up to 20 micrograms per kg per minute
(3) consider intravenous corticosteroid therapy
