Adjunctive Fludrocortisone in Septic Shock

Inclusion Criteria: 1. suspected or confirmed adult sepsis as defined by ≥ 2 increase in Sequential Organ Failure Assessment (SOFA) score due to infection 2. ≥0.25 μg/kg/min of noradrenaline infusion or vasoactive-inotropic score (VIS) ≥25 to maintain mean arterial pressure (MAP) ≥65 mmHg for at least 1 hour 3. onset of septic shock within 24 hours 4. shock due to infection with no other proven or apparent cause 5. hypoperfusion defined as arterial or venous lactate concentration \>2.0 mmol/L 6. mechanical ventilation Exclusion Criteria: 1. fludrocortisone cannot be administered within 24 hours of onset of septic shock 2. death is deemed imminent or inevitable by treating clinicians 3. limitation of therapy 4. an underlying disease process with a life expectancy of less than 90 days 5. pregnancy (confirmed or suspected) 6. receiving immunomodulatory agents including hydrocortisone \> 300mg/day 7. enteral medication cannot be administered 8. prescribed fludrocortisone for other medical condition 9. contraindication to hydrocortisone or fludrocortisone