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Early administration of low dose norepinephrine for the prevention of organ dysfunctions in patients with sepsis
Intensive Care Medicine Experimental volume 3, Article number: A417 (2015)
The importance of vasopressors in achieving the mean arterial pressure target in the early resuscitation of septic shock has been demonstrated and sepsis has been recently defined as a systemic response to infection with the presence of some degree of organ dysfunction [1, 2]. However, timing of norepinephrine (NE) for the prevention of organ dysfunctions in sepsis has not been investigated.
We studied the role of earlier low dose NE administration as a neurohormone rather than as a vasopressor for the prevention of organ dysfunctions in sepsis.
To achieve and maintain MAP at ≥ 70 mm Hg and central venous oxygen saturation ≥ 70%, in Group Early-NE (n = 16), fluid challenge and norepinephrine therapy concurrently was started within 6 hours at a dose of 0.1 µg/kg/min to a maximal dose of 0.3 µg/kg/min in sepsis patients with a decreasing trend in MAP from the baseline. Group Late-NE (n = 19) consisted of the sepsis patients whom hypoperfusion persists in spite of fluid resuscitation, and norepinephrine was started after 6 hours with the dosage like Early-NE. In both groups, the norepinephrine infusion was continued until the resolution of septic shock.
The average time to initial antimicrobial treatment was not significantly different in both groups. Mortality rate and organ dysfunctions (including cardiovascular, respiratory, coagulatory, renal and liver) were significantly lower in Group Early-NE.
Our results show that early administration of low dose norepinephrine in patients with sepsis is associated with a decreased organ dysfunctions and an increased survival rate. Although earlier vasopressor therapy can help to trigger the quality of delivered care, more importantly a decrease in net fluid balance seems to be the underlying key factor in our study. Early initiation of NE, as a new approach, should be assessed detailed regarding the pathophysiology of the organ dysfunctions in sepsis.
Bai X, Yu W, Ji W, Lin Z, Tan S, Duan K, et al: Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care. 2014, 18 (5): 532
Vincent JL, Opal SM, Marshall JC, Tracey KJ: Sepsis definitions: time for change. Lancet. 2013, 381 (9868): 774-775. 10.1016/S0140-6736(12)61815-7.
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Arslantas, M., Gul, F., Kararmaz, A. et al. Early administration of low dose norepinephrine for the prevention of organ dysfunctions in patients with sepsis. ICMx 3 (Suppl 1), A417 (2015). https://doi.org/10.1186/2197-425X-3-S1-A417
- Septic Shock
- Organ Dysfunction
- Sepsis Patient
- Early Administration