Cardiovascular Effects of Norepinephrine

Patients presenting with septic shock for 24 hours or more and meeting the inclusion criteria may be included.

The course of the study will be as follows:

T0: collection (as part of usual care) of clinical circulatory parameters (heart rate, systolic/diastolic/mean blood pressure) and biological parameters (arterial lactate and ScVo2) and performance of echocardiography.

Parameters collected during TTE:

• Concerning the main judgment criterion and the secondary judgment criteria:

• Left ventricular ejection fraction (LVEF) by the Simpson Biplane method,
• Cardiac output and cardiac index by continuity equation (measurement of left ventricular outflow chamber (mm) and sub-aortic time-velocity integral (cm/s)).
• Tricuspid Annular Systolic Excursion (TAPSE) (mm)
• S wave at the tricuspid ring (cm/s)
• Other parameters collected systematically:

• Surface of the left ventricle (end-systolic and end-diastolic),
• Global strain of the left ventricle
• Mitral Annular Plane Systolic Excursion (MAPSE) (mm)
• Left ventricular filling pressure (LVRP) (at the mitral annulus, E, A, e', S' waves, E/A ratio, E/e');
• Maximum tricuspid regurgitation velocity (m/s) to estimate systolic pulmonary arterial pressure (PAPs) (mmHg)

T1: After the clinician in charge introduces or increases norepinephrine to achieve MAP ≥ 65mmHg, T1 will be when the goal of MAP ≥ 65mmHg is reached. This will be the target MAP for the management of septic shock of the patient in question according to the recommendations of learned societies.

Collection of clinical and biological circulatory parameters and performance of the TTE. The parameters collected will be the same as at T0.

Inclusion criteria

• Adult patients >18 years old
• Septic shock after 24 hours from its diagnosis
• MAP<65 mmHg for which the physician in charge decided to increase NE

Exclusion criteria

• Patient under Dobutamine
• Pregnancy
• Do not resuscitation decision