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SourceControl1.Aspecificanatomicaldiagnosisofinfectionrequiringconsiderationforemergentsourcecontrolbesoughtanddiagnosedorexcludedasrapidlyaspossible,andinterventionbeundertakenforsourcecontrolwithinthefirst12hrafterthediagnosisismade,iffeasible(grade1C).Where’stheinfection?BernardWheelerNEJM336:912,19972.Wheninfectedperipancreaticnecrosisisidentifiedasapotentialsourceofinfection,definitiveinterventionisbestdelayeduntiladequatedemarcationofviableandnonviabletissueshasoccurred(grade2B).3.Whensourcecontrolinaseverelysepticpatientisrequired,theeffectiveinterventionassociatedwiththeleastphysiologicinsultshouldbeused(eg,percutaneousratherthansurgicaldrainageofanabscess)(UG).4.Ifintravascularaccessdevicesareapossiblesourceofseveresepsisorsepticshock,theyshouldberemovedpromptlyafterothervascularaccesshasbeenestablished(UG).Vasopressors1.Vasopressortherapyinitiallytotargetameanarterialpressure(MAP)of65mmHg(grade1C).2.Norepinephrineasthefirstchoicevasopressor(grade1B).（1-30ug/min）3.Epinephrine(potentiallysubstitutedfornorepinephrine)(grade2B).4.Vasopressin0.03units/minute（UG）6.Dopamineasanalternativevasopressoragenttonorepinephrineonlyinhighlyselectedpatients(eg,patientswithlowriskoftachyarrhythmiasandabsoluteorrelativebradycardia)(grade2C).8.Low-dosedopamineshouldnotbeusedforrenalprotection(grade1A).9.Allpatientsrequiringvasopressorshaveanarterialcatheterplacedassoonaspracticalifresourcesareavailable(UG).
NorepinephrinecomparedwithdopamineinseveresepsisInotropicTherapy1.Atrialofdobutamineinfusionupto20ug/kg/minbeadministeredoraddedtovasopressor(ifinuse)inthepresenceof(a)myocardialdysfunctionassuggestedbyelevatedcardiacfillingpressuresandlowcardiacoutput,or(b)ongoingsigns
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