Release of pro-inflammatory cytokin

Release of pro-inflammatory cytokines and dysregulation of the host immune response to infection may result in circulatory abnormalities. Peripheral vasodilation and damage to the glycocalyx, a complex glycoprotein layer lining the lumen of vascular endothelium, are associated with capillary leak and a subsequent decrease in circulating intravascular volume.1 It has long been accepted that reduced intravascular volume contributes to the decreased cardiac output, reduced tissue oxygen delivery, and organ dysfunction (eg, cardiac, pulmonary, renal) encountered in sepsis.2 Fluid resuscitation, to restore intravascular volume and improve oxygen delivery, has been a cornerstone of sepsis management for centuries.