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State of acute circulatory failure characterized by persistent arterial hypotension despite adequate fluid resuscitation or by tissue hypoperfusion (lactate >4mg/dL) unexplained by other causes

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The need to allocate time preoptimise the patient needs to be balanced against the need to operate to remove the septic focus.

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"Radial artery pressure underestimates central pressure in hypotensive septic patients receiving high-dose vasopressor therapy. Clinical management, based on radial pressures, may lead to excessive vasopressor administration. Awareness of this phenomena may help minimize adverse effects of these potent agents by enabling dosage reduction." refl.in/j6

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FEAST trial in African children showed better outcomes in children with febrile medical illness & impaired perfusion (not diarrhoea/burn) receiving maintenance vs fluid bolus therapy refl.in/79

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Consider post-operative high dependency/intensive care admission if large volumes of fluid are administered, inotropes are required, or signs of organ failure exist.

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