Early and exclusive use of norepinephrine in septic shock

Hiroshi Morimatsu, Kulgit Singh, Shigehiko Uchino, Rinaldo Bellomo, Graeme Hart

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

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] μg/(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.

Original languageEnglish
Pages (from-to)249-254
Number of pages6
JournalResuscitation
Volume62
Issue number2
DOIs
Publication statusPublished - Aug 2004
Externally publishedYes

Fingerprint

Septic Shock
Norepinephrine
Arterial Pressure
Mortality
Tertiary Healthcare
Artificial Respiration
Intensive Care Units
Maintenance
Outcome Assessment (Health Care)
Databases
Survival
Simplified Acute Physiology Score

Keywords

  • Blood pressure
  • Catecholamines
  • Catecolaminas
  • Choque séptico
  • Cuidados Intensivos
  • Intensive care
  • Lactate
  • Lactato
  • Norepinefrina
  • Norepinephrine
  • Pressão arterial
  • Reanimação
  • Resuscitation
  • Septic shock
  • Shock séptico

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Early and exclusive use of norepinephrine in septic shock. / Morimatsu, Hiroshi; Singh, Kulgit; Uchino, Shigehiko; Bellomo, Rinaldo; Hart, Graeme.

In: Resuscitation, Vol. 62, No. 2, 08.2004, p. 249-254.

Research output: Contribution to journalArticle

Morimatsu, Hiroshi ; Singh, Kulgit ; Uchino, Shigehiko ; Bellomo, Rinaldo ; Hart, Graeme. / Early and exclusive use of norepinephrine in septic shock. In: Resuscitation. 2004 ; Vol. 62, No. 2. pp. 249-254.
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abstract = "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] μg/(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.",
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