Norepinephrine in septic shock: when and how much?

Current Opinion in Critical Care
Olfa HamzaouiJ L Teboul

Abstract

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 literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoids fluid overload. Recent data are in favor of targeting a mean arterial pressure of at least 65 mmHg and higher values in case of chronic hypertension. When hypotension is refractory to norepinephrine, it is recommended adding vasopressin, which is relatively deficient during sepsis and acts on other vascular receptors than α1-adernergic receptors. However, increasing the dose of norepinephrine further cannot be discouraged. Early administration of norepinephrine is beneficial for septic shock patients to restore organ perfusion. The mean arterial pressure targe...Continue Reading

References

Apr 20, 2004·Critical Care Medicine·R Phillip DellingerUNKNOWN Surviving Sepsis Campaign Management Guidelines Committee
Jun 24, 2005·Intensive Care Medicine·Marjut VarpulaVille Pettilä
Jan 21, 2006·Critical Care Medicine·Jean-Louis VincentUNKNOWN Sepsis Occurrence in Acutely Ill Patients Investigators
May 23, 2006·The New England Journal of Medicine·UNKNOWN National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials NetworkAndrea L Harabin
Nov 11, 2006·Annals of Emergency Medicine·Stephen TrzeciakUNKNOWN Microcirculatory Alterations in Resuscitation and Shock Investigators
Jun 19, 2007·Intensive Care Medicine·Jacques CreteurJean-Louis Vincent
Feb 29, 2008·The New England Journal of Medicine·James A RussellUNKNOWN VASST Investigators
Jul 23, 2009·Critical Care : the Official Journal of the Critical Care Forum·Imad AbboudChristophe Faisy
Jul 31, 2010·Critical Care : the Official Journal of the Critical Care Forum·Olfa HamzaouiJean-Louis Teboul
Apr 12, 2012·American Journal of Respiratory and Critical Care Medicine·Mark E MikkelsenDerek C Angus
Aug 23, 2012·Chest·Samuel M BrownAlan H Morris
Aug 29, 2012·Critical Care Medicine·Romain PersichiniXavier Monnet
Mar 19, 2014·The New England Journal of Medicine·Pierre AsfarUNKNOWN SEPSISPAM Investigators
Jun 12, 2014·Critical Care Medicine·Nattachai AnantasitJames A Russell
Oct 4, 2014·Critical Care : the Official Journal of the Critical Care Forum·Xiaowu BaiNing Li
Feb 13, 2015·Critical Care : the Official Journal of the Critical Care Forum·Jean-Sebastien Rachoin, Richard P Dellinger
Jul 1, 2015·Shock·Claude MartinMarc Leone
Jun 13, 2016·Intensive Care Medicine·Glenn Hernández, Jean-Louis Teboul
Jul 12, 2016·American Journal of Respiratory and Critical Care Medicine·Roeland F StolkMatthijs Kox
Nov 20, 2016·Annals of Intensive Care·Xavier MonnetJean-Louis Teboul
Jan 20, 2017·Intensive Care Medicine·Andrew RhodesR Phillip Dellinger
Apr 21, 2017·Annals of Intensive Care·Thomas AuchetBruno Levy

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Citations

Feb 13, 2019·Expert Review of Anti-infective Therapy·Jean-Louis Vincent, Wasineenart Mongkolpun
Nov 13, 2019·Journal of Clinical Nursing·Stephanie HunterElizabeth Manias
Oct 3, 2019·JAMA : the Journal of the American Medical Association·Pierre-Francois LaterreUNKNOWN SEPSIS-ACT Investigators
Feb 1, 2019·Annals of Intensive Care·Thomas W L ScheerenJean-Louis Teboul
Aug 9, 2020·Critical Care : the Official Journal of the Critical Care Forum·Yuting LiDong Zhang
Nov 19, 2020·International Journal of Immunopathology and Pharmacology·Dawei KangYanjun Zhao
Nov 29, 2020·Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses·Nans FlorensMartin Cour
May 4, 2021·The Journal of Surgical Research·Kathleen E SingerMichael D Goodman

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