The goal of this observational study is to learn about the change of hemodynamic response from intravenous fluid versus medical (vasopressor) resuscitation by echocardiogram in septic shock patient.

The main question it aims to answer is:

How hemodynamic response change from intravenous fluid versus medical (vasopressor) resuscitation by echocardiogram in septic shock patient?

Participants already receiving the appropriate resuscitation at that time by their medical staff as part of their regular medical care for septic shock. The echocardiogram will assess before and after resuscitation.

The goal of this observational study is to learn about the change of hemodynamic response from intravenous fluid versus medical (vasopressor) resuscitation by echocardiogram in septic shock patient.

The investigators enrolled septic shock patients, who required hemodynamic resuscitation. Then the investigators performed baseline echocardiogram to measured stroke volume, cardiac output and E/Ea before start resuscitation. In fluid resuscitation group, patient will received either fluid resuscitation about 200 mL to 500 mL before preformed echo after fluid resuscitation. In vasopressor group, patient will received norepinephrine titration dose about 0.05 mcg/kg/min, before performed echocardiogram. Then the investigators compare the different change between those resuscitation with fluid and with vasopressor titration, in term of stroke volume, cardiac output, cardiac index and E/Ea change.

Inclusion Criteria:

• Adult patients aged ≥18 years
• Diagnosis with Septic Shock (Sepsis-3 Definition of Septic Shock)
• Hypotension, SBP < 90 mmHg, or mean arterial BP < 65 mmHg

Exclusion Criteria:

• Patients who receive two or more vasopressors
• Patients who receive inotropic medications
• Patients who receive simultaneously fluid with vasopressor resuscitation
• Patients with insufficiently quality ultrasound images for determining echocardiography
• Patients or their legally authorized representatives (LAR), who decline participation in the study or are unable to provide informed consent before enrollment

Adult critically ill patients whom admitted to either medical or surgical intensive care units (MICU, SICU) at Siriraj Hospital