Severe sepsis is a leading cause of death characterised by infection-induced endothelial and cardiac dysfunction leading to hypovolaemia, maldistribution of flow, tissue ischaemia and organ failure. A clinical approach with focus on cardiovascular diagnostics and rational goal-directed therapy is likely to reduce the high mortality. The treatment involves focus control, broad-spectrum antibiotics, target-oriented fluid therapy and vasopressor and inotropic agents guided by frequent reassessments of the patient's response to treatment.