Study SOLACE SEPSIS

Inclusion criteria

• Subjects will be eligible for the trial if they meet all of the following criteria:
• Age criteria: 18 - 90 years
• Septic shock - Sepsis 3 criteria :
• acute change in total SOFA score ≥ 2 due to infection
• use of vasopressor drug to maintain target mean arterial pressure ≥ 65 mmHg
• blood lactate level ≥ 2 mmol/L within last 24 hours
• Likely need for fluid resuscitation
• poor peripheral perfusion as evidenced by 2 out of 4: i. peripheral cyanosis with delayed capillary refill ≥ 3 seconds ii. low urinary output (\< 0.5 ml/kg/hour for at least 6 hours) iii. central venous O2 saturation \< 70% iv. clouded sensorium/poor mentation
• dynamic assessment of preload responsiveness as evidenced by 1 out of 3: i. positive passive leg raising test ii. pulse pressure variation and / or stroke volume variation2, both \> 12% iii. distensibility index of inferior vena caval diameter \> 12%
• Signed the relevant informed consent form

Exclusion criteria

• Subjects will not be eligible for the trial if they meet any of the following criteria:
• Poor transthoracic echo windows
• Actual body weight \> 160 kg
• Hypernatremia: \[Na\] \> 150 mEq/L
• Cardiac tamponade
• Uncorrected severe valvular heart disease or life-threatening arrhythmia
• Moribund patients likely to die before the study protocol is completed
• Patients with absolute indication for immediate acute hemodialysis/hemofiltration (within 2 hrs) based on pH \< 7.0, K \> 7.0mmol/L
• Severe liver dysfunction defined by total serum bilirubin \> 120 umol/l
• Pregnancy and lactation