Skip to main content

Volume 3 Supplement 1


Septic shock and the use of norepinephrine in a high dependency unit - mortality and adverse events


Septic shock is associated with high mortality. Elderly and multimorbid patients are not always eligible for intensive care unit (ICU) admission. Intravenous (IV) infusion of norepinephrine (NE) is an accepted treatment for hypotension in septic shock. Use of a vasopressor outside the ICU is poorly evaluated.


To describe the severity of disease using Acute Physiology and Chronic Health Evaluation (APACHE-II) scoring, mortality and adverse events (AE); in patients with septic shock receiving IV fluid and NE in a high dependency unit (HDU) at the Dept of Medicine.


A retrospective review of 91 patients with sepsis treated with antibiotics, IV fluids and NE for hypotension. Data on HDU- and 30-day mortality, standardized mortality ratio (SMR) as well as adverse events (necrosis and arrhythmia) were collected. The route of administration of fluids and NE, via peripheral venous catheter (PVC) or central venous catheter (CVC), was registered. All patients were monitored with pulse oximetry, a 3-point ECG and had blood pressure measured non-invasively. Nurse:patient ratio was ≥ 1:3 in the HDU.


Median age (min-max) was 81 (43-96) years and median APACHE-II was 26 (12-42) points. Patients not reaching a mean arterial pressure (MAP) >65 mm Hg within 12 hours had poor outcome, see Figure 1. HDU-mortality was 27 % (n = 25), with SMR as 0.443 (95 % CI: 0.287-0.654); and 30-day mortality was 47 % (n = 43). NE (maximum 0.2 microgram/kg/min) was administered via PVC in 87 % (n = 79) and via CVC in 13 % (n = 12) of patients, duration up to 72 hours. No skin necrosis was noted; one patient developed sinus tachycardia and died shortly after having the NE-infusion stopped.

Figure 1
figure 1

Patient survival (%).


Patients treated with NE for hypotension in septic shock had a better HDU survival than expected. This study does not indicate frequent AEs when administering NE via a PVC.

Author information

Authors and Affiliations


Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hallengren, M., Åstrand, P., Eksborg, S. et al. Septic shock and the use of norepinephrine in a high dependency unit - mortality and adverse events. ICMx 3 (Suppl 1), A877 (2015).

Download citation

  • Published:

  • DOI: