Aggressive volume resuscitation is considered to be the best initial therapy for the management of patients with hypotension. Volume resuscitation is initiated with fluid boluses of 500 mL, titrated to BP (ie, MAP), heart rate, urine output, and respiratory status. In patients with the systemic inflammatory response syndrome due to sepsis or other causes, hypotension may persist despite vigorous volume expansion. These patients require treatment with a vasopressor agent. Traditionally, dopamine has been regarded as the pressor of choice as it was believed that this agent would maintain renal, cerebral, coronary, and splanchnic blood flow. Furthermore, it was taught that norepinephrine was to be avoided at all costs as this agent caused severe vasoconstriction. However, some data have suggested that both of these widely held “truths” are incorrect. The “reno-protective” effects of dopamine have been debunked, and this agent may paradoxically impair splanchnic mucosal blood flow.4–7 At the same time, the deleterious effects of norepinephrine have not been confirmed, and indeed it has been demonstrated that this agent increases organ and tissue blood flow in patients in various disease states.