Early initiation of norepinephrine may reduce mortality in Sepsis, finds study

China: Early initiation of norepinephrine in septic shock patients is associated with shorter time to achieve target MAP, decreased short-term mortality, and less volume of IV fluids within 6 h, suggests a recent study in the BMC journal Critical Care. Further, the study found no significant difference in ICU length of stay between late and early groups.

Septic shock remains one of the most challenging problem in ICUs. Mortality remains between 25 and 50% of those afflicted, with an increasing annual incidence in the developed world. Septic shock patients can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain mean arterial pressure (MAP) ≥ 65 mmHg and having a serum lactate level > 2 mmol/L (18 mg/dL) despite adequate volume resuscitation. 

Norepinephrine is both an alpha1- and beta1-agonist and is, therefore, able to increase vascular tone and contractility. Recent guidelines recommend norepinephrine as the first-line vasopressor in septic shock. The effect of the timing of norepinephrine initiation on clinical outcomes in patients with septic shock is uncertain. To fill this knowledge gap Yuting Li, The First Hospital of Jilin University, Changchun, Jilin, China, and colleagues performed a systematic review and meta-analysis to evaluate the impact of an early and late start of norepinephrine support on clinical outcomes in septic shock patients.