Norepinephrine Plus Dobutamine Versus Epinephrine Alone for the Management of Septic Shock

Inclusion Criteria: * Adults over 18 years * Informed consent Presenting from less than 7 days : * One or more infectious site * At least 2 of the following criteria: temperature \> 38°C or \< 36.5°C, respiratory rate \> 20 breaths per min or PaCO2 \< 32 mmHg or mechanical ventilation, heart rate \> 90 beats/min, white blood cell count \> 12,000/mm3 or \< 4,000/mm3 * At least 2 of the following criteria: PaO2/FiO2 ratio \<280 mmHg (if mechanical ventilation, urinary output of less than 0.5 mL/kg of body weight or \< 30 mL/h at least 1 hour, plasma lactate \> 2 mmol/L, platelet count \< 100,000 /mm3 And presenting from at least 24 hours: * Systolic blood pressure \< 90 mmHg or mean blood pressure \< 70 mmHg (for at least 30 min); * 1000 mL fluid replacement or pulmonary capillary wedge pressure \> 12 mmHg * Dopamine infusion at 15 µg/kg/min for at least 1 hour, or epinephrine or norepinephrine in first intention Exclusion Criteria: * Pregnant woman * Obstructive cardiomyopathy * Acute coronary disease * Non infectious shock * Care limitation * White blood cell count \< 500 /mm3