Early and exclusive use of norepinephrine in septic shock.

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.