The final event in septic shock is multiorgan failure syndrome as a consequence of hypoperfusion resulting from a late, refractory vasodilatory shock. Before starting vasoactive agents, the underlying infectious disease must be under treatment, the volume status aggressively corrected, the immunomodulatory therapy started, and adrenal gland failure ruled out. NE is the vasoactive agent with the best results in refractory shock, and it is probably the vasoconstrictor that most improves mortality in septic patients. VP levels are depleted in the late phase of septic shock. If the patient is hypotensive, even though vasoactive agents and inotropes are used, VP should be started at low doses.
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