Effect of Dynamic Arterial Elastance and Assisted Fluid Management Software Guided Resuscitation in Septic Shock: Pilot Study

Inclusion Criteria: * All Thai consecutive patients older than 18 years with a diagnosis of sepsis or septic shock in medical ICU, defined by clinically suspected or confirmed infection and MAP \<65 mmHg according to the criteria of the Surviving Sepsis Campaign 2021(11)with onset of shock in less than 24 hours. * Already receiving or planning for mechanical ventilation * Already receiving or planning for arterial catheter placement for invasive arterial pressure monitoring * All patients will receive an echocardiogram with a cut point of LVEF \> 30% to be included in the study Exclusion Criteria: * Active, immediate, life-threatening cardiac arrhythmia, defined as ventricular tachycardia and ventricular fibrillation * Acute cerebral vascular event, including both acute ischemic stroke or intracranial hemorrhage * Acute coronary syndrome * cardiogenic shock, acute heart failure * Severe asthma exacerbation * Fluid intolerance: hypoxemia (P:F ratio \< 150) * Life-threatening gastrointestinal hemorrhage * Pregnancy * Requirement for immediate surgery within 2 hours of randomization * Advanced-stage cancer with predicted survival of less than 6 months * Oliguric AKI with signs of volume overload Withdrawal or termination criteria * The patient and legal representative request for withdrawal * The attending physician requested a withdrawal