Please select the eligibility criteria that correspond to the clinical trial below.
Title: Prospective, Randomized Study on Two Parallel Groups Comparing Dopexamine and Norepinephrine in Combination to Epinephrine Alone on Systemic and Pulmonary Hemodynamics, Gastric Mucosal Perfusion, and Oxidative Stress in Septic Shock
Brief Summary: In septic shock, when volume resuscitation fails to restore mean arterial pressure, catecholamines such as dopamine, dobutamine, epinephrine, or norepinephrine are used, either alone or in combination. Although they allow hemodynamic success to be obtained, they can leave some regional blood flows impaired, especially the hepatosplanchnic perfusion, which contributes to multiple organ failure.

Dopexamine is a structural and synthetic analog of dopamine that exerts systemic and gut vasodilation and stimulates cardiac contraction. In experimental models, dopexamine has been shown to exert anti-inflammatory properties and to protect the hepatic ultra structure. The combination of dopexamine and norepinephrine could therefore constitute an interesting alternative in treating septic shock patients. This study will test the efficacy (on gastric mucosal blood flow, hepatic damage and oxidative stress) and safety of the combination of dopexamine and norepinephrine (compared to those of epinephrine alone) in the treatment of patients with septic shock.


Options:
A: Inclusion Criteria:

* Clinical diagnosis of Septic shock
* vasopressor support to maintain mean arterial pressure (MAP) between 65 and 75 mmHg despite adequate volume resuscitation (pulmonary artery occlusion pressure = 13-18 mmHg and central venous pressure = 8-12 mmHg)

Exclusion Criteria:

* Pregnancy
* Present cardiac dysfunction
* Present or suspected acute mesenteric ischemia
B: Inclusion Criteria:

1. High-output shock
2. Cardiovascular SOFA score of \> 4
3. Cardiac Index \> 2.4 liters/min/BSA 1.73m2
4. Indwelling arterial line already present as part of standard care
5. Age \> 21 years of age
6. Signed consent form
7. Use of indwelling urinary catheter as standard care expected at least for 12 hours during the study interventions

Exclusion Criteria:

1. Patients with acute coronary syndrome
2. Patients with a known history of vasospasm
3. Patients with a history of asthma
4. Patients currently experiencing bronchospasm
5. Patients with active bleeding with an anticipated need for \> 4 units of PRBC or Hemoglobin \< 7g/dL or any other condition that would contraindicate drawing serial blood samples
C: Inclusion Criteria:

* Adults over 18 years
* Informed consent
* Septic shock with:

  * evidence of infection;
  * at least 3 of the following criteria: temperature \> 38°C or \< 36.5°C; respiratory rate \> 20 breaths per minute 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: plasma lactate \> 2 mmol/L or unexplained metabolic acidosis (pH \< 7.3); hypoxemia defined by PaO2 \< 70 mmHg at room air or a PaO2/FiO2 ratio \< 280 mmHg (or \< 200 mmHg if pneumonia was the source of sepsis) or need for mechanical ventilation; urine output \< 30 mL/h for at least 2 hours despite a fluid challenge of at least 500mL; a platelet count \< 100,000/mm3, a decrease of 50% from previous value, or unexplained coagulopathy (prothrombin time \< 60% and elevated fibrin degradation products \> 10 μg/mL);
  * systolic blood pressure \< 90 mmHg despite an optimal volume loading defined by a pulmonary capillary wedge pressure \> 12 mmHg.

Exclusion Criteria:

* Pregnant women
* Patients with a history of esophageal or gastric disease
* Patients with a history of esophageal or gastric surgery
D: Inclusion criteria:

* At least 18 years of age
* Suspected infection
* Two or more systemic inflammatory response syndrome (SIRS) criteria

  * Temperature \</= 36˚ C or \>/= 38˚C
  * Heart rate \>/= 90 beats per minute
  * Mechanical ventilation for acute respiratory process or respiratory rate \>/= 20 breaths per minute or PaC02 \< 32 mmHg
  * WBC \>/= 12,000/mm³ OR \</= 4,000/mm³ OR \> 10% bands
* Refractory hypotension (a systolic blood pressure \< 90 mm Hg despite an IV fluid challenge of at least 1,000 mLs over a 30 minute period) or evidence of hypoperfusion (a blood lactate concentration \>/= 4 mmol/L)

Exclusion criteria:

* Known pregnancy
* Primary diagnosis of acute cerebral vascular event, acute coronary syndrome, acute pulmonary edema, status asthmaticus, major cardiac arrhythmia, active gastrointestinal hemorrhage, seizure, drug overdose, burn or trauma
* Requirement for immediate surgery
* ANC \< 500/mm³
* CD4 \< 50/mm³
* Do-not-resuscitate status
* Advanced directives restricting implementation of the protocol
* Contraindication to central venous catheterization
* Contradiction to blood transfusion (e.g., Jehovah's Witness)
* Treating physician deems aggressive care unsuitable
* Participation in another interventional study
* Transferred from another in-hospital setting

Answer: C