ObjectiveTo evaluate the use of the selective α1-adrenergic receptor agonist phenylephrine in the hemodynamic support of patients with septic shock.DesignRetrospective analysis of clinical use of phenylephrine.SettingSurgical ICU in a university hospital.PatientsThirteen patients with septic shock (diagnosed by defined criteria) requiring pharmacologie support for the treatment of hypotension.Interventions and Main ResultsAll patients underwent invasive hemodynamic monitoring followed by volume resuscitation and inotropic support to reverse flow-dependent oxygen consumption and lactic acidosis. Patients with persistent hypotension (mean arterial pressure [MAP] <65 mm Hg) and vasodilation (systemic vascular resistance index [SVRI] <1500 dyne-sec/cm5-m2received phenylephrine at iv infusion rates of 0.5 to 9 μg/kg·min to maintain MAP >70 mm Hg. MAP, SVRI, left ventricular stroke work index, and stroke volume index were significantly (p < .05) increased after phenylephrine administration and at the time of highest oxygen consumption (&OV0312;o2). Cardiac index was unchanged initially but increased at the time of highest &OV0312;o2(p< .05). Pulmonary artery occlusion pressure and heart rate were unchanged. Average baseline &OV0312;o2increased from 145 to 200 mL/min·m2and oxygen delivery (&U1E0A;o2) increased from 447 to 597 mL/min-m2during phenylephrine treatment (p< .05). Blood lactate concentrations decreased and urine output increased significantly (p< .05), while serum creatinine concentrations remained unchanged during phenylephrine therapy.ConclusionsTreatment with phenylephrine was associated with beneficial hemodynamic effects when used to maintain perfusion, while increasing &U1E0A;o2and &OV0312;o2in patients with septic shock.