Introduction

Key goals in treating the hypotensive patient include normalization of arterial perfusing pressures and maintenance of tissue O 2 delivery at levels consistent with ongoing O2 requirements. As the occurrence of primary multiple organ dysfunction syndrome increases in relation to the time taken to restore perfusing pressures and tissue oxygenation, timely reversal of hypotension is critical. Successful management also demands an organized and practiced approach; communicating clear objectives to the healthcare team and repeated evaluation of the management plan are crucial to ensuring successful outcomes. An added challenge is the need to treat at the same time that the precipitating cause of hypotension is being identified and controlled. Management will be discussed in the context of treatment periods which occur in sequence, namely ebb phase resuscitation, which includes restoring arterial pressures to either preinjury levels or levels consistent with adequate organ perfusion, followed by flow phase resuscitation, which necessitates supporting tissue O 2 delivery both to repay any O2 debt created by the initial hypotensive episode and simultaneously to provide for ongoing tissue O2 demands

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