Acute circulatory failure.

Sophisticated techniques for invasive and noninvasive monitoring of the cardiovascular, respiratory and metabolic consequences of shock, together with application to therapy of nutritional implications of disordered substrate metabolism that preferentially consumes vital protein stores, will result in further reduction of mortality, particularly in septic shock. Early recognition of the responsible hemodynamic abnormality and its underlying cause, followed by monitored fluid challenge and the selective rather than routine use of vasoactive drugs, is the basis of current shock therapy. As more is learned of the profound catabolic and related hyperdynamic abnormalities of severe sepsis, it is apparent that therapy will be redirected toward provision of energy substrates and altering hormonal patterns to favor anabolism.