Key messages

• The fundamental principle of management is the early restoration of organ perfusion and oxygenation with concurrent diagnosis and treatment of the initial insult.

• Restoring perfusion and oxygenation requires resuscitation of the cardiovascular and respiratory systems and transfusion of red cells to restore adequate oxygen-carrying capacity.

• At present the use of supranormal oxygen delivery goals in established shock has not been proved to improve outcome.

• Specific therapies directed at preventing further organ damage should be used to halt the progression to multiple organ failure.

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