 Inclusion Criteria: severe sepsis and septic shock acording to the Sepsis Campaign 2013 crieria patients with medical or surgical pathology which are admitted in the ICU unit in the first six hours after the onset of the severe sepsisseptic shock. The exclusion criteria of the patients are age less then 18 and more then 75, cardiac valvular pathology with hemodynamic importance, cardiac failure NYHA III și IV, primary or secondary pulmonary hypertension with hemodymanic impact with onset before the onset of the septic pathology,severe liver failure Child-Pugh C, anuric renal failure, pregnant women, patient who refuse blood products adminitration, end-stage cancer. 