Norepinephrine in septic shock: when and how much?

  title={Norepinephrine in septic shock: when and how much?},
  author={Olfa Hamzaoui and Thomas W. L. Scheeren and Jean-Louis Teboul},
  journal={Current Opinion in Critical Care},
Purpose of review Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension when high doses of norepinephrine are required to reach the target. Recent findings Recent literature has reported benefits of early administration of norepinephrine… 
Central venous pressure value can assist in adjusting norepinephrine dosage after the initial resuscitation of septic shock
After patients with septic shock (Sepsis-3) resuscitated to reach the initial recovery target goals, combination of CVP and MAP refer to usual levels can help doctors make the next decision to make the correct choice of increase NE dosage or decrease NE dosage.
The initial resuscitation of septic shock.
Importance of haemodynamic stability and adjuvant therapy in the treatment of patients with sepsis and septic shock
Early detection of sepsis and septic shock within the first hour and immediate adequate fluid administration with vasoactive medications to maintain hemodynamic stability, are crucial for achievement of better outcome of these patients.
Early low-dose norepinephrine in patients with septic shock
  • K. Nugent, C. Peña
  • Medicine, Biology
    The Southwest Respiratory and Critical Care Chronicles
  • 2019
The results from the CENSER trial (Early Use of Norepinephrine in Septic Shock Resuscitation) were published in the May issue of the American Journal of Respiratory and Critical Care Medicine and the investigators did not use vasopressin.
Hypothesis: Fever control, a niche for alpha-2 agonists in the setting of septic shock and severe acute respiratory distress syndrome?
Rigorous prospective randomized trials are needed in subsets of patients with a high fever and spiraling toward refractory septic shock and/or presenting with severe ARDS to simplify critical care management when limited cardio-ventilatory reserve is at stake.
Adjusting mean arterial pressure alarms improves the time spent within blood pressure targets in patients with septic shock: A quasi-experimental study.
  • N. Florens, B. Chabert, M. Cour
  • Medicine
    Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
  • 2020
Non-antibiotic therapies for sepsis: an update
Management of the patient with sepsis remains a challenge and needs to be personalized, and the search for new immunomodulatory drugs continues and will be facilitated by better characterization of patients using modern ‘omics’ technology and complex analysis of the large quantities of clinical data increasingly available.
Effect of norepinephrine combined with sodium phosphocreatine on cardiac function and prognosis of patients with septic shock
Results show that NE administration at 2 h after fluid infusion may be the optimal time point for the treatment of SS and NE combined with SP treatment can improve early cardiac dysfunction and 28-day survival outcomes in patients with SS.
Fluid management in the critically ill.


Timing of norepinephrine in septic patients: NOT too little too late
Data is reported that reveals an association between earlier vasopressor initiation in septic shock and better outcome, and whether this is a linkage to better care, is related to improved early tissue perfusion, or relates to sparing of fluids to reach the MAP target.
Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension
Early administration of norepinephrine aimed at rapidly achieving a sufficient perfusion pressure in severely hypotensive septic-shock patients is able to increase cardiac output through an increase in cardiac preload and cardiac contractility.
Effects of norepinephrine on mean systemic pressure and venous return in human septic shock*
In septic shock patients, decreasing the dose of norepinephrine decreased the mean systemic pressure and, to a lesser extent, the resistance to venous return, as a result, venousReturn decreased.
Early versus delayed administration of norepinephrine in patients with septic shock
It is shown that early administration of norepinephrine in septic shock patients is associated with an increased survival rate, and this effect on hospital mortality is significantly different between the Early-NE and Late-NE groups.
Outcome of patients with septic shock and high-dose vasopressor therapy
In total, 40% of septic shock patients receiving high-dose vasopressor therapy survived at day 28 after admission, showing that administration of high- doses of vasopression may indeed be useful in these patients.
Potentially Inadvertent Immunomodulation: Norepinephrine Use in Sepsis.
It is concluded that although the development of novel therapies aimed at reversing immunoparalysis is underway, the use of norepinephrine may aggravate the development, extent, and duration of sepsis-induced immunopralysis.
Survival after shock requiring high-dose vasopressor therapy.
One in six patients with shock survived to 90 days after HDV; the majority of nonsurvivors died after withdrawal or withholding of life support therapy; stress-dose corticosteroid therapy appears reasonable in patients withshock requiring HDV.
Norepinephrine: Not too Much, too Long
The dosage of norepinephrine associated with an intensive care unit (ICU) death rate greater than 90% and the death rate reached 90% for the quantile of patients receiving more than 1 &mgr;g/kg per minute of norpinephrine were determined.
Restoring arterial pressure with norepinephrine improves muscle tissue oxygenation assessed by near-infrared spectroscopy in severely hypotensive septic patients
Norepinephrine administration aimed at achieving a MAP higher than 65 mmHg in septic shock patients with life-threatening hypotension resulted in improvement of NIRS variables measured at the level of the thenar eminence.
Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine
This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock.