Comparison of Landiolol Versus Standard of Care for Prevention of Mortality in Patients Hospitalized for a Septic Shock With Hypercontractility

Inclusion criteria

• Age ≥ 18 years old
• Patient admitted for a septic shock (according to the SEPSIS3 definition: sepsis with persisting hypotension (MAP<65mmHg or SAP <90mmHg) requiring vasopressors to maintain MAP>65mmHg and having a serum lactate level >2 mmol/L
• Patient who received at least 30ml/kg of fluid and absence of fluid responsiveness
• Left ventricular ejection fraction >65% (visual or Simpson method using echocardiography)
• Tachycardia >100 bpm in sinus rhythm with a MAP 65mmHg for more than 1 hour
• Patient receiving invasive mechanical ventilation
• Patients adapted to the ventilator under sedation and analgesia
• Written informed consent
• Patient covered by French national health insurance

Exclusion criteria

• Patients with inclusion criteria already present for more than 36 hours
• Patient treated with Dobutamine, adrenaline or isoprenaline
• Patient currently treated with beta blockers (previous home betablocker treatment is not an exclusion criteria)
• Supra ventricular (atrial fibrillation or flutter) or ventricular arrhythmias
• Patients with any form of cardiac pacing
• Sick sinus syndrome
• Severe atrioventricular (AV) nodal conductance disorders (without pacemaker): 2nd or 3rd degree AV block
• Known pulmonary hypertension
• ScVO2 <70%
• Moribund
• Cardiac arrest
• Non-treated phaeochromocytoma
• Acute asthmatic attack
• Pregnant or breastfeeding woman
• Patient deprived of liberty by administrative or judicial decision or placed under judicial protection (guardianship or supervision),
• Age <18 years
• Hypersensitivity to the active substance or to any of the excipients
• Severe bradycardia (less than 50 beats per minute)
• Cardiogenic shock
• Severe hypotension
• Decompensated heart failure when considered not related to the arrhythmia
• Severe, uncorrectable metabolic acidosis
• Presence of significant bleeding, or
• Acute respiratory distress defined by increased oxygen dependency, polypnea > 30 /min, signs of struggle (pulling, thoraco-abdominal sway) if the patient is not intubated and ventilated.