Olfa Hamzaoui1, Thomas W L Scheeren, Jean-Louis Teboul. 1. aHôpitaux universitaires Paris-Sud, Hôpital Antoine Béclère, service de réanimation polyvalente, Clamart, France bDepartment of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands cHôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale dINSERM UMR S_999, Univ Paris-Sud, Le Kremlin-Bicêtre, France.
Abstract
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 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. SUMMARY: Early administration of norepinephrine is beneficial for septic shock patients to restore organ perfusion. The mean arterial pressure target should be individualized. Adding vasopressin is recommended in case of shock refractory to norepinephrine.
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 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. SUMMARY: Early administration of norepinephrine is beneficial for septic shockpatients to restore organ perfusion. The mean arterial pressure target should be individualized. Adding vasopressin is recommended in case of shock refractory to norepinephrine.
Authors: Thomas W L Scheeren; Jan Bakker; Daniel De Backer; Djillali Annane; Pierre Asfar; E Christiaan Boerma; Maurizio Cecconi; Arnaldo Dubin; Martin W Dünser; Jacques Duranteau; Anthony C Gordon; Olfa Hamzaoui; Glenn Hernández; Marc Leone; Bruno Levy; Claude Martin; Alexandre Mebazaa; Xavier Monnet; Andrea Morelli; Didier Payen; Rupert Pearse; Michael R Pinsky; Peter Radermacher; Daniel Reuter; Bernd Saugel; Yasser Sakr; Mervyn Singer; Pierre Squara; Antoine Vieillard-Baron; Philippe Vignon; Simon T Vistisen; Iwan C C van der Horst; Jean-Louis Vincent; Jean-Louis Teboul Journal: Ann Intensive Care Date: 2019-01-30 Impact factor: 6.925