Early Use of Norepinephrine Improves Survival of Patients With Septic Shock
By Chris Berrie
BERLIN -- October 3, 2019 -- Early use of norepinephrine at the onset of diagnosis of septic shock might cause earlier restoration of blood pressure, better lactate clearance, and consequently better in-hospital survival, researchers reported here at the 32nd Annual Congress of the European Society of Intensive Care Medicine (ESICM).
“The timing of initiation of norepinephrine in septic shock is still controversial,” explained Khaled Taema, MD, Cairo University, Cairo, Egypt. “The most recent guidelines recommend its use after failed trial of fluid resuscitation. We intended in this study to evaluate the impact of early starting norepinephrine simultaneously with fluids resuscitation immediately after diagnosis of septic shock.”
The researchers randomised patients admitted to the Emergency Department with septic shock to receive norepinephrine together with IV fluids resuscitation (n = 57) or after failure of IV fluids resuscitation (n = 44), as defined by achieving mean arterial pressure ≥65 mm Hg.
In-hospital survival -- the primary endpoint -- was significantly higher in the early norepinephrine group (71.9% vs 45.5%; P = .007).
“Starting early norepinephrine at the earliest point in the Emergency Department appears to improve in-hospital survival,” said Dr. Taema.
A higher number of patients in the norepinephrine group achieved lactate clearance (P = .017). Post-resuscitation serum lactate levels were significantly reduced for the early group (P = .005).
The target mean arterial pressure of ≥65 mm Hg was achieved at a significantly earlier time in the early group compared with the late group (2 vs 3 hours; P = .003). This was accompanied by the need for significantly less resuscitation volume for the early intervention group (25.0 vs 32.5 mL/kg; P
Patients with early norepinephrine were resuscitated by significantly lower volume of fluids compared with the late group.
Finally, there was significantly shorter median time to start of norepinephrine seen for survivors (30 vs. 120 min; P = .013).
[Presentation title: Early use of Norepinephrine Improves Survival in Septic Shock: Earlier Than Early]