No Benefit to Early Initiation of Norepinephrine for Septic Shock

A meta-analysis of 12 studies of early versus late initiation of norepinephrine demonstrated similar mortality and intensive care unit length of stay.

Fluid resuscitation and initiation of vasopressors are two initial critical steps to support patients with septic shock. Most clinicians opt to use norepinephrine as a first-line agent, although debate persists about how soon to start it. A large trial in which vasopressors were initiated early in fluid resuscitation failed to show benefit (NEJM JW Gen Med Mar 1 2023 and N Engl J Med 2023; 388:499).

Investigators performed a meta-analysis of 12 studies (4 randomized trials and 8 observational studies) of >7000 patients with septic shock who were treated with norepinephrine started either early or late with respect to fluid resuscitation. Definitions of “early” and “late” differed between studies.

Mortality was the same between early and late …

Reviewing Author

Patricia Kritek, MD

Disclosures

Editorial BoardsATS Scholar

Patricia Kritek, MD

Disclosures

Editorial BoardsATS Scholar

No Benefit to Early Initiation of Norepinephrine for Septic Shock

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Reviewing Author