Can a sedative improve blood flow in septic shock? a pilot study investigates

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Age 18-85 years. * Diagnosis of septic shock according to Sepsis-3 criteria, defined as suspected or documented infection with vasopressor requirement to maintain mean arterial pressure ≥65 mmHg and serum lactate \>2 mmol/L after adequate fluid resuscitation. * Enrollment within 24 hours after diagnosis of septic shock in the ICU. * Receiving invasive mechanical ventilation. * Receiving continuous intravenous sedative and/or analgesic therapy other than dexmedetomidine before enrollment, with a clinical decision to add dexmedetomidine for sedation management. * Continuous norepinephrine infusion at enrollment. * PiCCO catheter in place and PiCCO-based hemodynamic monitoring available before dexmedetomidine initiation. * Written informed consent obtained from the patient or legally authorized representative. Exclusion Criteria: * Shock primarily caused by non-septic etiologies, including cardiogenic, hypovolemic, obstructive, hemorrhagic, or anaphylactic shock. * Expected death or withdrawal of life-sustaining treatment within 24 hours. * Known allergy or hypersensitivity to dexmedetomidine. * Severe bradycardia or clinically significant conduction abnormality before enrollment, including heart rate \<50 beats/min, second-degree or third-degree atrioventricular block, sick sinus syndrome, or other conduction abnormality without a functioning pacemaker. * Severe uncontrolled arrhythmia, acute coronary syndrome, or clinically significant myocardial ischemia before enrollment. * Severe hemodynamic instability judged unsuitable for dexmedetomidine by the treating physician, including refractory hypotension or rapidly escalating vasopressor requirement. * Severe hepatic dysfunction judged by the investigator to substantially increase the risk of dexmedetomidine accumulation or adverse effects. * Conditions interfering with sublingual microcirculatory assessment, including major oral or sublingual lesions, active oral bleeding, inability to access the sublingual area, or poor baseline image quality. * Pregnancy or lactation. * Participation in another interventional clinical trial that may affect study outcomes or safety.