Early norepinephrine use in septic shock

Olfa Hamzaoui; Rui Shi

doi:10.21037/jtd.2019.12.50

Early norepinephrine use in septic shock

J Thorac Dis. 2020 Feb;12(Suppl 1):S72-S77. doi: 10.21037/jtd.2019.12.50.

Authors

Olfa Hamzaoui¹, Rui Shi^{2

3}

Affiliations

¹ Service de réanimation polyvalente, Hôpital Antoine Béclère, AP-HP, Hôpitaux universitaires Paris-Sud, Clamart, France.
² INSERM-UMR_S999 LabEx - LERMIT, Hôpital Marie-Lannelongue, Le Plessis Robinson, France.
³ Service de médecine intensive - réanimation, Hôpital Bicêtre, AP-HP, Hôpitaux universitaires Paris-Sud, Le Kremlin-Bicêtre, France.

Abstract

As vascular tone depression is a hallmark of septic shock, administration of norepinephrine is logical in this setting. In this article, we provide and develop the following arguments for an early use of norepinephrine-the recommended first-line vasopressor-in septic shock: (I) prevention of prolonged severe hypotension, (II) increase in cardiac output through an increase in cardiac preload and/or contractility, (III) improvement of microcirculation and tissue oxygenation, (IV) prevention of fluid overload, and (V) improvement of outcome. Presence of a low diastolic arterial pressure as a marker of depressed vascular tone can be used as a trigger to initiate norepinephrine urgently.

Keywords: Norepinephrine; fluid administration; septic shock; vasopressor.

Publication types

Review