Optimal VAsopressor titraTION Pilot Randomized Controlled Trial

Inclusion Criteria

• Who are receiving vasopressors for distributive shock
• Who are older than 16 years of age at the time of eligibility.
• Who are under the direct care of the ICU team regardless of location.
• Who have received a minimum of 30 mL/kg of intravenous fluids (2100 mL for a 70 kg patient) before enrolment OR the most responsible physician has good reasons to believe that more fluid resuscitation is no longer required and could be harmful.
• Who the treating physician believes will need vasopressors for at least 6 hours once enrolled.

Exclusion Criteria

• Have received vasopressors for more than 24 consecutive hours; if vasopressors are discontinued for >= 2 hours then restarting vasopressors will constitute a distinct vasopressor episode and the clock will be reset.
• Are judged by the treating physician to be in obvious cardiogenic shock after an acute myocardial infarction (based on new ST segment elevations on ECG or obvious echocardiographic findings).
• Have obvious haemorrhagic shock as a consequence of a clearly identified source of blood loss.
• Require vasopressors after cardiac surgery as a result of cardiopulmonary bypass-induced hypotension.
• Who have a specific indication for catecholamine therapy other than shock (i.e. angioedema or intracranial hypertension).
• If the attending team has agreed to withhold or withdraw life sustaining care.
• Concurrent enrollment in interventional trials that do not meet guidelines (see ccctg.ca) for co-enrollment (co-enrollment is permissible if there is no potential interaction between the protocols; this will be addressed case by case).
• Prior randomization in this study.