RApid Fluid Volume EXpansion in Patients in Shock After the Initial Phase of Resuscitation.

Inclusion Criteria

• •Pre-eligibility criteria:
• •Patients presenting on Intensive Care Unit (ICU) admission or later during their ICU stay with arterial hypotension (Mean arterial pressure \[MAP\]\<65mmHg or systolic arterial pressure \[SAP\]\< 90 mmHg at least two times over a 15-minute interval), regardless of the method used to measure blood pressure (invasive or non invasive),
• •Or patients already receiving continuous iv vasopressor therapy on ICU admission, regardless of the blood pressure level, will be considered as potential candidates for inclusion in the study, depending on his/her clinical evolution after 6 to 24 hours of care according to current guidelines for shock management.
• •In case arterial hypotension is present and/or the patient is already receiving continuous iv vasopressor at ICU admission, the date and time of admission will be considered as the time of shock onset (H0).
• •In case arterial hypotension occurs after ICU admission, the date and time of the first episode of hypotension will be considered as the time of shock onset (H0).
• •Patients will be eligible for inclusion if 6 hours after H0 (and before H24) all the following conditions are present:
• •Informed consent obtained (or emergency inclusion possible when legal representatives and patient's family are not present, as allowed by the Ethic Committee and by the French Law)
• •Persistence of arterial hypotension (as defined above) or continuous iv infusion of norepinephrine
• •Patient under invasive mechanical ventilation
• •At least one of the following conditions is present
• •Alteration of consciousness
• •Mottling skin
• •Cyanosis of the extremities despite SaO2\>90%
• •Oliguria defined as urine output below 0.5ml/kg of actual body weight over at least 1 hour
• •Arterial lactate \> 2 mmol/L
• •ScvO2 \< 70%
• •Central venous (internal jugular or subclavian) or femoral venous catheter in place
• •Arterial catheter in place