COMPARATIVE STUDY OF NORADRENALINE ALONE VERSUS NORADRENALINE AND TERLIPRESSIN FOR MANAGEMENT OF SEPTIC SHOCK IN ICU: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY.

Sepsis is defined as a life threatening organ dysfunction caused by a dysregulated host response to infection. Vasoactive drugs are important to maintain the stability of hemodynamics and ensure the perfusion of major organs. Noradrenaline is the first line of drug for septic shock.The aim of the study is to  compare noradrenaline alone versus noradrenaline and terlipressin combined in the management of septic shock in ICU. The study will be conducted in the central intensive care unit, Tezpur Medical College and Hospital for a period of 1 year which is a prospective randomized controlled study. The study will include patient age more than 18 years with septic shock presenting with mean arterial pressure <65 mmHg despite appropriate volume resuscitation. The participants will be recruited and randomized by using computer created random number technique using the allocation ratio 1:1. Group 1 patients will received terlipressin 0.01 mcg/kg/min ( fixed dose infusion) and infusion noradrenaline 0.01-3 mcg/kg/min and group 2 patients will received infusion noradrenaline 0.01-3 mcg/kg/min. Primary outcome is to measure the dose of noradrenaline require to achieve target mean arterial pressure of 65-70 mmHg after 12 hours of infusion. And secondary outcomes are to measure the length of ICU stayed, duration of vasopressor requirement, changes in the serum lactate level, urine output in ml/hour, changes in qSOFA in 12 hours post-initiation of infusion and incidence of serious adverse events like digital ischaemia, cardiac arrythmias, diarrhoea and upper GI bleed.