Overview

Fluid management is one of the key issues in the initial management of septic shock (SS). Fluid overload and hypovolemia have been associated with increased mortality in several trials. Transthoracic echocardiography (TTE) and lung ultrasound are recommended for haemodynamic assessment in critically ill patients. However, the benefit of hemodynamic optimisation using echography has not been yet evaluated. The purpose of this multicenter, controlled, randomized trial is to assess the impact of an echocardiographic algorithm of hemodynamic optimization on fluid management in septic patients during the first 4 days of therapy.

Eligibility

All eligible patients will have a cardiac echocardiogram prior to inclusion for the sole

        purpose of eliminating special situations that are part of the non-inclusion criteria
        listed below.
        Inclusion Criteria
          -  Patient in an intensive care unit who develops septic shock on admission or during
             hospitalization, as defined by SEPSIS-3 criteria.
          -  Patient or trusted person / legal representative / family member / curator / guardian
             who has given free and informed consent and has signed the consent form or patient
             included in an emergency situation.
          -  Patient affiliated or beneficiary of a health insurance plan.
          -  Patient at least (≥) 18 years of age.
        Exclusion Criteria:
          -  Refusal of consent.
          -  Patient under court protection or guardianship.
          -  Moribund patient with a life expectancy of less than 48 hours.
          -  Non-echogenic patient.
          -  Cardiac tamponade.
          -  Infective endocarditis.
          -  Intracavitary thrombus.
          -  Dilated cardiomyopathy with LVEF (Left Ventricular Ejection Fraction<40%.
          -  Parturient or nursing patient.