Quel agent vasopresseur utiliser au cours du choc septique ?

Sepsis is related to the host reaction secondary to infection. Most of the mechanisms of organ perfusion regulation are disturbed, leading to a deficit in oxygen tissue consumption. Septic shock treatment is based on predetermined objectives such as: preload independency, mean arterial pressure higher than 65 mmHg, and urinary output higher than 0.5 ml/kg/h. The use of vasopressors allows maintaining organ perfusion pressure required to preserve tissue metabolism. Previous fluid expansion guided by hemodynamic and echocardiographic measurements, is mandatory to avoid hypovolemia. Norepinephrine is the gold standard for patients in septic shock. It must be used early, as soon as preload is optimized. Epinephrine can be used alternately. Vasopressin is indicated in patients unresponsive to norepinephrine. Dopamine increases septic shock-related mortality and is contra-indicated in this setting. Achieving advances in therapeutic strategy is more important than the choice of vasopressors themselves.