嚴重敗血症及敗血性休克是敗血症常見之嚴重併發症。近幾年來由於對敗血症的認知越來越成熟，不管在病理、診斷及治療方面都有顯著的進步。2004年戰勝敗血症治療指引的發表，更有助於臨床醫師對嚴重敗血症及敗血性休克病患，儘早診斷、處置與治療成效之提昇。
在嚴重敗血症或敗血性休克引起的組織灌流不全徵候一旦被發現，需立即實施復甦療法。依早期目標療法，開始6小時內能達到以下的目標：中央靜脈壓（central venous pressure；CVP）：8~12毫米汞柱。平均動脈壓（mean arterial pressure；MAP）大於等於65毫米汞柱。尿量每小時每公斤體重大於等於0.5毫升。中央靜脈或混合靜脈血氧飽和度大於等於70％，會降低28天內的死亡率。起初6小時的黃金復甦期間，若經過輸液治療後，中央靜脈壓已達到8-12毫米汞柱時，而中央靜脈血氧或混合靜脈血氧飽和度仍達不到70％，那就必須輸注濃縮紅血球使血容比達到30％，或者可同時給予dobutamine以達到中央靜脈血氧或混合靜脈血氧飽和度大於70％為目標。在嚴重敗血症及敗血性休克期，即使經輸液復甦治療、升壓劑及強心劑仍無法反轉低血壓之狀態，vasopressin和corticosteroid適時適量的加入，已證明確實有實質助益。本文除將以上所列之藥以藥理機轉、療效指標、常見副作用分別敘述外，並將臨床應用上的考量因素加以分析，希望能提供臨床藥師面對重症病患治療之參考。

Septic shock and severe sepsis are the most severe complications of sepsis. In recent years, exciting advances have been made in the understanding of pathophysiology, diagnosis and treatment of sepsis. The resuscitation of a patient in severe sepsis or sepsis-induced tissue hypoperfusion should begin as soon as the syndrome is recognized and should not be delayed ICU admission.
During the first 6 hrs of resuscitation, the goals of initial resuscitation of sepsis-induced hypoperfusion should include all of the following as one part of a treatment protocol: Central venous pressure: 8–12 mm Hg, Mean arterial pressure >=65 mm Hg, Urine output >=0.5 mL·kg-1·hr-1, Central venous or mixed venous oxygen saturation >=70%, During the first 6 hrs of resuscitation of severe sepsis or septic shock, if central venous oxygen saturation or mixed venous oxygen saturation of 70% is not achieved with fluid resuscitation , then transfuse packed red blood cells to achieve a hematocrit of >=30% and/or administer a dobutamine infusion (up to a maximum of 20 µg·kg-1·min-1) to achieve this goal. 
When an appropriate fluid challenge fails to restore adequate blood pressure and organ perfusion, therapy with vasopressor agents should be started. Vasopressin use may be considered in patients with refractory shock despite adequate fluid resuscitation and high-dose conventional vasopressors. Intravenous corticosteroids (hydrocortisone 200–300 mg/day, for 7 days in three or four divided doses or by continuous infusion) is recommended in patients with septic shock who, despite adequate fluid replacement, require vasopressor therapy to maintain adequate blood pressure.