title: New directions for sepsis and septic shock research.
abstract: BACKGROUND
  Septic shock is a frequent complication in intensive care unit that can result in multiple organ failure and death. In addition, recent data suggested that severe sepsis and septic shock represent an economic burden. Therefore, septic shock is an important public health problem.
  
  
  METHODS
  In this review, we will focus on the recent evidences concerning the stages of septic shock, the complex macrocirculation and microcirculation relationship, and the importance of those evidences for future resuscitation goals and therapeutic strategies during late septic shock.
  
  
  RESULTS
  Recently, two stages of septic shock are suggested. In early stage, hypovolemia is the main contributing factor. During this stage, macrocirculatory and microcirculatory changes run parallel, and fluid resuscitation seems to be effective in restoring the hemodynamic parameters. Late stage of septic shock is characterized by complex microcirculation and macrocirculation relationship.
  
  
  CONCLUSIONS
  Although early goal-directed therapy is a stepwise approach in the treatment of septic shock, tissue perfusion remains an important factor that contributes to septic shock outcome. Because appropriate monitoring of tissue perfusion is a matter of debt, the ideal therapeutic strategy remains a controversial issue that needs further investigations.
authors.affiliation: Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: nivinsharawi@gmail.com.
authors.forename: Nivin
authors.initials: N
authors.lastname: Sharawy
authors.affiliation: Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Lehmann
mesh_terms: D001775:Blood Circulation; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D014655:Vascular Resistance; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents
keywords: Septic shock; Tissue perfusion; Vasopressor agents