The patient now becomes progressively
more vasoconstricted and hypotensive.
Volume replacement is tried, but fails
to raise the cardiac index and results
in a rise of the pulmonary wedge
pressure to 32. PVC's rise to 6/min.
Urine output falls to 10 cc/hr. A mild
metabolic acidosis is present: pH 7.30,
pCO2 38, HCO3 17.

How would you proceed?