Optimal VAsopressor titraTION Pilot Randomized Controlled Trial

Inclusion Criteria: 1. Who are receiving vasopressors for distributive shock 2. Who are older than 16 years of age at the time of eligibility. 3. Who are under the direct care of the ICU team regardless of location. 4. Who have received a minimum of 30 mL/kg of intravenous fluids (2100 mL for a 70 kg patient) before enrolment OR the most responsible physician has good reasons to believe that more fluid resuscitation is no longer required and could be harmful. 5. Who the treating physician believes will need vasopressors for at least 6 hours once enrolled. Exclusion Criteria: 1. Have received vasopressors for more than 24 consecutive hours; if vasopressors are discontinued for \>= 2 hours then restarting vasopressors will constitute a distinct vasopressor episode and the clock will be reset. 2. Are judged by the treating physician to be in obvious cardiogenic shock after an acute myocardial infarction (based on new ST segment elevations on ECG or obvious echocardiographic findings). 3. Have obvious haemorrhagic shock as a consequence of a clearly identified source of blood loss. 4. Require vasopressors after cardiac surgery as a result of cardiopulmonary bypass-induced hypotension. 5. Who have a specific indication for catecholamine therapy other than shock (i.e. angioedema or intracranial hypertension). 6. If the attending team has agreed to withhold or withdraw life sustaining care. 7. Concurrent enrollment in interventional trials that do not meet guidelines (see ccctg.ca) for co-enrollment (co-enrollment is permissible if there is no potential interaction between the protocols; this will be addressed case by case). 8. Prior randomization in this study.