Ivabradine for Heart Rate Control In Septic Shock

Exclusion Criteria

• •Age \< 18 years,
• •Cardiac arythmia, conduction disorder, sinus syndrome ("sick sinus syndrome"), sino-atrial block; 3rd degree atrioventricular block, "IRISS" protocol, version 6.0 of 30/10/2023 7/47 This document is the property of DRCD / APHP. All reproduction is strictly prohibited.
• •Cardiogenic shock or unstable or acute heart failure without proven or suspected infection,
• •Acute myocardial infarction with angiographic documentation; CCS class
• •≥ II angina pectoris;
• •Septic shock requiring vasopressor treatment for more than 24 hours,
• •Refractory shock with systolic arterial pressure \<90 mm Hg) despite the use of high doses of vasopressors (norepinephrine BASE or epinephrine BASE \> 2.4 µg/kg/min; these doses should be multiplied by two for noradrenaline salt (tartrate or bitartrate),
• •Co-treatment with drugs inducing bradycardia, QT lengthening or strong inhibition of CYP4503A4, pacemaker, defibrillator, kalemia \<3 mM,
• •Co-treatment with verapamil or diltiazem (which are moderate CYP4503A4 inhibitors with heart rate reducing properties)
• •Known pregnancy, breast feeding, women with childbearing potential will be tested for pregnancy and excluded if pregnant,
• •Known allergy to ivabradine or to any of the excipients, retinitis pigmentosa, congenital galactosemia, lactase deficiency, glucose or galactose malabsorption,
• •Severe chronic renal failure (creatinine clearance \<15 ml/min) or hepatic failure (prothrombin time \<20%),
• •Enteral feeding impossible, vomiting, congenital galactosemia, lactase deficiency, glucose-galactose malabsorption syndrome,
• •Tachycardia due to hyperthyroidism, pheochromocytoma or severe anemia (\<7 g/dL),
• •Prior enrolment in the trial, participation in another interventional study on septic shock,
• •Known legal incapacity (patients under guardianship or curatorship),
• •Decision to limit full care taken before obtaining informed consent,
• •Patient under AME (state emergency medical help),
• •Lack of affiliation to social security.