Comparison of Angiotensin II to Standard Dose Vasopressors on Change in Arterial Elastance

Inclusion Criteria: * Age ≥ 18 years at the time of enrollment * Septic shock as defined by Sepsis-3 criteria (highly suspected or confirmed infection, requiring norepinephrine to maintain a MAP ≥ 65 mmHg, and serum lactate \> 2 mmol/L after adequate fluid resuscitation) within a 48 hour window prior to enrollment * Confirmed cirrhotic patient (Radiological/Biopsy/Physician confirmed) * Preserved cardiac function as assessed using point-of-care ultrasonography or a non-invasive hemodynamic monitoring device with either LVOT VTI \> 18 cm or stroke volume \> 50 ml Within 48 hours of onset of shock. * Standard of care vasopressors are at a norepinephrine equivalent of 15 mcg/min Exclusion Criteria: * Declined consent. * Pregnancy * CKD-Stage IV/V * ESRD on long-term hemodialysis * On Dialysis or planned dialysis to be initiated within 24 hours of study of enrollment. * Clinically determined to have primarily hepatorenal syndrome. * On other vasoactive medication (phenylephrine, Terlipressin, epinephrine, dobutamine, dopamine) * Hemorrhagic, obstructive, or hypovolemic shock is not the primary cause of shock based on clinical judgement. * DNR * Patients declared Brain dead. * Anticipated death within 48 hours of enrollment * Echocardiographic windows not available * Acute mesenteric Ischemia * Active gastrointestinal bleeding * Active cardiac ischemic event defined as NSTEMi, STEMI * Acute DVT/Pulmonary embolism/Portal vein thrombosis * \> 48 h since initiation of vasopressor …