The document provides recommendations for hemodynamic support and adjunctive therapy for patients with severe sepsis and septic shock. It recommends crystalloids as the initial fluid of choice and against the use of hydroxyethyl starches. It also recommends targeting a mean arterial pressure of 65 mm Hg with norepinephrine as the first choice vasopressor. Dobutamine may be used for patients with myocardial dysfunction. Hydrocortisone may be used if fluid resuscitation and vasopressor therapy are unable to restore hemodynamic stability.