Several data emphasize the relation between tachycardia (\>90/min) and high mortality during septic shock. The investigators previously demonstrated the high mortality associated with hypercontractility, tachycardia and the presence of a left ventricular obstruction. A severe hypovolemia, a hyper adrenergic stimulation or a severe vasoplegia can all explain this relation between tachycardia, hypercontractility and the mortality during septic shock.
Landiolol is another short-term acting beta-blocker with a half-life of 4 minutes without any beta 2 activity or membrane stabilizing effect. The landiolol has been used in critically ill patients to control supraventricular tachycardia but not in this context of tachycardia and septic shock. The investigators hypothesize that landiolol by reducing the heart rate may improve the survival of patients treated for a septic shock and presenting with an hypercontractility state.
Age ≥ 18 years old
Patient admitted for a septic shock (according to the SEPSIS3 definition: sepsis with persisting hypotension (MAP<65mmHg or SAP <90mmHg) requiring vasopressors to maintain MAP>65mmHg and having a serum lactate level >2 mmol/L
Patient who received at least 30ml/kg of fluid and absence of fluid responsiveness
Left ventricular ejection fraction >65% (visual or Simpson method using echocardiography)
Patients with inclusion criteria already present for more than 36 hours
Patient treated with Dobutamine, adrenaline or isoprenaline
Patient currently treated with beta blockers (previous home betablocker treatment is not an exclusion criteria)
Supra ventricular (atrial fibrillation or flutter) or ventricular arrhythmias
Parallel
echocardiography
Other interventionFull echocardiography will be performed at baseline and during the follow-up at H1, H3, H6 and H12.
Landiolol
DrugPatients randomized to the experimental group will be treated according to the standard of care plus for 2 days with landiolol IV started at a dose of 1 microgram/kg/min and progressively increased every 10 minutes to a maximum of 40 micrograms/kg/min.
Variation of mortality rate in landiolol group compared to control group
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Centre Hospitalier Universitaire, Amiens
Lead sponsor
CH Dieppe
Collaborator
CH Elbeuf
Collaborator
CH Le Havre
Collaborator
Centre Hospitalier de Beauvais
Collaborator
CH Compiègne
Collaborator
CH Laon
Collaborator
University Hospital, Caen
Collaborator
CH Cherbourg
Collaborator
University Hospital, Lille
Collaborator
CH Douai
Collaborator
CH Montreuil
Collaborator
Centre Hospitalier de Roubaix
Collaborator
Centre Hospitalier de Bethune
Collaborator
CH Lomme
Collaborator
Centre Hospitalier de Lens
Collaborator
Tourcoing Hospital
Collaborator
Centre Hospitalier VALENCIENNES
Collaborator
Centre Hospitalier Arras
Collaborator
Hospital Ambroise Paré Paris
Collaborator
University Hospital, Brest
Collaborator
Henri Mondor University Hospital
Collaborator
Hospital Avicenne
Collaborator
University Hospital, Montpellier
Collaborator
CH Calais
Collaborator
Hôpital Edouard Herriot
Collaborator
Centre Hospitalier Universitaire de Nīmes
Collaborator
Groupe Hospitalier Pitie-Salpetriere
Collaborator
Hôpital Louis Mourier, Colombes
Collaborator
