Introduction 1 2 The present clinical review briefly discusses the splanchnic vascular anatomy and focuses on the different therapeutic approaches that have been proposed to promote perfusion of the gastrointestinal tract during resuscitation of patients with septic shock. When possible and reasonable, we propose therapeutic recommendations. N Anatomy of hepatosplanchnic vascular bed 1 3 4 4 5 6 7 8 9 10 12 13 CO 2 CO 2  CO 2 CO 2  14 CO 2  CO 2  15 CO 2  10 16 CO 2  Therapeutic strategies Fluid challenge 17 18 19 20 22 CO 2  CO 2  20 23 24 25 26 Adrenergic drugs The choice of vasoactive drugs in sepsis and septic shock is controversial. There is no evidence that any one vasoactive drug is more effective or safer than any other. Larger trials are needed to elucidate existing clinically significant differences in morbidity and mortality. A multicentre trial, which is currently ongoing, is comparing the effects of epinephrine with a combination of a fixed dose of dobutamine in addition to norepinephrine. 1 27 27 30 CO 2  30 28 31 2 32 33 34 32 34 35 CO 2  CO 2  1 2 3 24 24 36 37 39 39 40 41 CO 2  CO 2  40 42 39 43 44 45 11 46 CO 2  38 42 41 43 CO 2  2 3 Recommendations regarding use of adrenergic drugs 45 Dopexamine 30 47 7 48 49 50 CO 2  51 Other vasoactive drugs Vasopressin and terlipressin 52 53 54 52 55 CO 2  56 CO 2  56 CO 2  57 60 61 CO 2  62 63 64 CO 2  Both vasopressin and terlipressin are potent vasoconstrictors and both are able to restore blood pressure in vasodilatory or septic shock. However, the effects on splanchnic blood flow are not yet fully elucidated. Clearly, adequacy of volume resuscitation is a major prerequisite for maintenance of microcirculatory blood flow. The currently available data suggest that both substances administered to compensate for endogenous vasopressin deficiency may be beneficial. Although the armamentarium for treatment of septic shock is enriched by such substances, it remains unclear whether administration during septic shock decreases morbidity or improves survival, and further research is warranted. Enoximone 65 66 P  Prostacyclin 67 68 69 70 71 CO 2  72 Nitroglycerin 73 N-acetyl cysteine N 74 75 76 CO 2  75 77 78 Extracorporeal renal support CO 2  79 80 81 CO 2  80 82 81 Conclusion CO 2  Competing interests None declared. Abbreviations N CO 2