Abstract
Septic shock is one of the main causes of admission and death in critically ill patients [1]. Septic shock is characterized by a combination of hypovolemia, peripheral vascular dysfunction resulting in hypotension and abnormalities in the local/ regional distribution of blood flow, cardiac failure and cell dysfunction. Importantly, the hemodynamic profile differs from patient to patient. In some septic patients, hypovolemia is predominant. In others, a marked decrease in vascular tone or myocardial depression is in the forefront of the hemodynamic failure. A variety of combinations can thus exist. In addition to macrocirculatory disorders, microcirculatory abnormalities contribute to tissue hypoxia through altered oxygen extraction. Whatever the macro- and microcirculatory disturbances, the prognosis of septic shock is tightly linked to how soon antibiotic therapy and hemodynamic management are initiated, including administration of fluid and of vasopressors to target a mean arterial pressure (MAP) > 65mmHg [1]. Currently, the early use of vasopressors is one of the emerging concepts in the hemodynamic management of septic shock that may change our practice. In this chapter, we will set out five reasons to support early initiation of vasopressors, and namely, of norepinephrine (Box 1).
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228
Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettila V (2005) Hemodynamic variables related to outcome in septic shock. Intensive Care Med 31:1066–1071
Dunser MW, Takala J, Ulmer H et al (2009) Arterial blood pressure during early sepsis and outcome. Intensive Care Med 35:1225–1233
Benchekroune S, Karpati PC, Berton C et al (2008) Diastolic arterial blood pressure: a reliable early predictor of survival in human septic shock. J Trauma 64:1188–1195
LeDoux D, Astiz ME, Carpati CM, Rackow EC (2000) Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 28:2729–2732
Bai X, Yu W, Ji W et al (2014) Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care 18:532
Dunser MW, Ruokonen E, Pettila V et al (2009) Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial. Crit Care 13:R181
Hamzaoui O, Georger JF, Monnet X et al (2010) Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension. Crit Care 14:R142
Monnet X, Jabot J, Maizel J, Richard C, Teboul JL (2011) Norepinephrine increases cardiac preload and reduces preload dependency assessed by passive leg raising in septic shock patients. Crit Care Med 39:689–694
Nouira S, Elatrous S, Dimassi S et al (2005) Effects of norepinephrine on static and dynamic preload indicators in experimental hemorrhagic shock. Crit Care Med 33:2339–2343
Deruddre S, Cheisson G, Mazoit JX, Vicaut E, Benhamou D, Duranteau J (2007) Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography. Intensive Care Med 33:1557–1562
Dubin A, Pozo MO, Casabella CA et al (2009) Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: a prospective study. Crit Care 13:R92
Thooft A, Favory R, Salgado DR et al (2011) Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care 15:R222
Desjars P, Pinaud M, Potel G, Tasseau F, Touze MD (1987) A reappraisal of norepinephrine therapy in human septic shock. Crit Care Med 15:134–137
Martin C, Papazian L, Perrin G, Saux P, Gouin F (1993) Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 103:1826–1831
Martin C, Viviand X, Arnaud S, Vialet R, Rougnon T (1999) Effects of norepinephrine plus dobutamine or norepinephrine alone on left ventricular performance of septic shock patients. Crit Care Med 27:1708–1713
Persichini R, Silva S, Teboul JL et al (2012) Effects of norepinephrine on mean systemic pressure and venous return in human septic shock. Crit Care Med 40:3146–3153
Maas JJ, Pinsky MR, de Wilde RB, de Jonge E, Jansen JR (2013) Cardiac output response to norepinephrine in postoperative cardiac surgery patients: interpretation with venous return and cardiac function curves. Crit Care Med 41:143–150
De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104
De Backer D, Donadello K, Sakr Y et al (2013) Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med 41:791–799
Jhanji S, Stirling S, Patel N, Hinds CJ, Pearse RM (2009) The effect of increasing doses of norepinephrine on tissue oxygenation and microvascular flow in patients with septic shock. Crit Care Med 37:1961–1966
Georger JF, Hamzaoui O, Chaari A, Maizel J, Richard C, Teboul JL (2010) Restoring arterial pressure with norepinephrine improves muscle tissue oxygenation assessed by near-infrared spectroscopy in severely hypotensive septic patients. Intensive Care Med 36:1882–1889
Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent JL (2007) The prognostic value of muscle StO2 in septic patients. Intensive Care Med 33:1549–1556
Trzeciak S, Dellinger RP, Parrillo JE et al (2007) Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med 49:88–98 (98 e81–82)
Vincent JL, Sakr Y, Sprung CL et al (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353
Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA (2011) Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 39:259–265
Acheampong A, Vincent JL (2015) A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care 19:251
Sennoun N, Montemont C, Gibot S, Lacolley P, Levy B (2007) Comparative effects of early versus delayed use of norepinephrine in resuscitated endotoxic shock. Crit Care Med 35:1736–1740
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Jozwiak, M., Monnet, X., Teboul, JL. (2016). Norepinephrine in Septic Shock: Five Reasons to Initiate it Early. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2016. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-27349-5_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-27349-5_6
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-27348-8
Online ISBN: 978-3-319-27349-5
eBook Packages: MedicineMedicine (R0)