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On a macroscopic level, sepsis progresses along a spectrum from infectious insult to septic shock and multiorgan dysfunction. 25  Septic shock is a form of distributive shock, manifested in patients by an increase in cardiac output and vasodilation. 24  The oxygen demand of end organs exceeds oxygen delivery, and with the cellular switch from aerobic to anaerobic metabolism, lactate is produced. 28  As oxygen demands remain unmatched, perfusion decreases leading to end organ failure. With each organ system failure, absolute mortality increases by 15%-20%. 27

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