BACKGROUND: The timing and use of norepinephrine (noradrenaline) (NE) in septic shock remain a matter of controversy. AIM: To study the outcome of septic patients treated with early and exclusive NE. SETTING: Tertiary Intensive Care Unit. PATIENTS: 142 patients with septic shock. INTERVENTION: Exclusive NE infusion within 24 hours of admission to ICU. METHODS AND MAIN RESULTS: Retrospective analysis of data from a unit database identified 142 patients. Their median admission simplified acute physiology score (SAPS II) score was 46 [38, 56] with 98 (69%) receiving mechanical ventilation. Mean arterial pressure (MAP) at the start of NE infusion was 60 [58, 68]mmHg. NE infusion was started at a median of 1.3 [0.3, 5.0]h after ICU admission. Restoration and maintenance of target MAP was achieved initially in all patients and, in 61.3%, within 30 min. The median peak dose of NE was 0.28 [0.14, 0.61]microg/(kg min) and the duration of infusion was 88 [42, 175]h. SAPS II predicted mortality was 40.8%, however, only 34.5% (P = 0.27) died. Among the most severely ill patients (SAPS II score >56) actual mortality was 50.0% versus 74.7% predicted (P = 0.07). CONCLUSIONS: Early and exclusive use of NE in hyperdynamic septic shock achieved a stable MAP >75 mmHg in all patients. Survival compared favorably with that predicted by illness severity scores.
BACKGROUND: The timing and use of norepinephrine (noradrenaline) (NE) in septic shock remain a matter of controversy. AIM: To study the outcome of septicpatients treated with early and exclusive NE. SETTING: Tertiary Intensive Care Unit. PATIENTS: 142 patients with septic shock. INTERVENTION: Exclusive NE infusion within 24 hours of admission to ICU. METHODS AND MAIN RESULTS: Retrospective analysis of data from a unit database identified 142 patients. Their median admission simplified acute physiology score (SAPS II) score was 46 [38, 56] with 98 (69%) receiving mechanical ventilation. Mean arterial pressure (MAP) at the start of NE infusion was 60 [58, 68]mmHg. NE infusion was started at a median of 1.3 [0.3, 5.0]h after ICU admission. Restoration and maintenance of target MAP was achieved initially in all patients and, in 61.3%, within 30 min. The median peak dose of NE was 0.28 [0.14, 0.61]microg/(kg min) and the duration of infusion was 88 [42, 175]h. SAPS II predicted mortality was 40.8%, however, only 34.5% (P = 0.27) died. Among the most severely ill patients (SAPS II score >56) actual mortality was 50.0% versus 74.7% predicted (P = 0.07). CONCLUSIONS: Early and exclusive use of NE in hyperdynamic septic shock achieved a stable MAP >75 mmHg in all patients. Survival compared favorably with that predicted by illness severity scores.
Authors: Joe Brierley; Joseph A Carcillo; Karen Choong; Tim Cornell; Allan Decaen; Andreas Deymann; Allan Doctor; Alan Davis; John Duff; Marc-Andre Dugas; Alan Duncan; Barry Evans; Jonathan Feldman; Kathryn Felmet; Gene Fisher; Lorry Frankel; Howard Jeffries; Bruce Greenwald; Juan Gutierrez; Mark Hall; Yong Y Han; James Hanson; Jan Hazelzet; Lynn Hernan; Jane Kiff; Niranjan Kissoon; Alexander Kon; Jose Irazuzta; Jose Irazusta; John Lin; Angie Lorts; Michelle Mariscalco; Renuka Mehta; Simon Nadel; Trung Nguyen; Carol Nicholson; Mark Peters; Regina Okhuysen-Cawley; Tom Poulton; Monica Relves; Agustin Rodriguez; Ranna Rozenfeld; Eduardo Schnitzler; Tom Shanley; Saraswati Kache; Sara Skache; Peter Skippen; Adalberto Torres; Bettina von Dessauer; Jacki Weingarten; Timothy Yeh; Arno Zaritsky; Bonnie Stojadinovic; Jerry Zimmerman; Aaron Zuckerberg Journal: Crit Care Med Date: 2009-02 Impact factor: 7.598
Authors: Yan Li; Xizhong Cui; Junwu Su; Michael Haley; Heather Macarthur; Kevin Sherer; Mahtab Moayeri; Stephen H Leppla; Yvonne Fitz; Peter Q Eichacker Journal: Crit Care Med Date: 2009-04 Impact factor: 7.598
Authors: Vance Beck; Dan Chateau; Gregory L Bryson; Amarnath Pisipati; Sergio Zanotti; Joseph E Parrillo; Anand Kumar Journal: Crit Care Date: 2014-05-12 Impact factor: 9.097
Authors: Lauren Page Black; Michael A Puskarich; Carmen Smotherman; Taylor Miller; Rosemarie Fernandez; Faheem W Guirgis Journal: J Am Coll Emerg Physicians Open Date: 2020-05-02