 - 2 or more criteria for systemic inflammatory response syndrome temperature 38 or36; heart rate 90 beats per minute; respiratory rate 20 breaths per minute or paCO2 32 mmHg; white blood cell count 12,000mm3, 4000mm3 or 10 immature forms and serum lactate level of 4mmoll and more or refractory hypotension - mean arterial pressure 65mmHg or systolic blood pressure 90mmHg after fluid challenge of 1000ml or more 30min 