Study SOLACE SEPSIS

Inclusion Criteria:

• Subjects will be eligible for the trial if they meet all of the following criteria:

1. Age criteria: 18 - 90 years

2. Septic shock - Sepsis 3 criteria :

3. acute change in total SOFA score ≥ 2 due to infection

4. use of vasopressor drug to maintain target mean arterial pressure ≥ 65mmHg

5. blood lactate level ≥ 2 mmol/L within last 24 hours

6. Likely need for fluid resuscitation

7. poor peripheral perfusion as evidenced by 2 out of 4: i. peripheralcyanosis 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

8. dynamic assessment of preload responsiveness as evidenced by 1 out of 3:i. positive passive leg raising test ii. pulse pressure variation and / orstroke volume variation2, both > 12% iii. distensibility index of inferiorvena caval diameter > 12%

9. Signed the relevant informed consent form

Exclusion Criteria:

• Subjects will not be eligible for the trial if they meet any of the followingcriteria:

1. Poor transthoracic echo windows

2. Actual body weight > 160 kg

3. Hypernatremia: [Na] > 150 mEq/L

4. Cardiac tamponade

5. Uncorrected severe valvular heart disease or life-threatening arrhythmia

6. Moribund patients likely to die before the study protocol is completed

7. Patients with absolute indication for immediate acutehemodialysis/hemofiltration (within 2 hrs) based on pH < 7.0, K > 7.0mmol/L

8. Severe liver dysfunction defined by total serum bilirubin > 120 umol/l

9. Pregnancy and lactation