EBQ:Early versus delayed administration of norepinephrine in patients with septic shock.

incomplete Journal Club Article

Xiaowu Bai, Wenkui Yu*, Wu Ji, Zhiliang Lin, Shanjun Tan, Kaipeng Duan, Yi Dong, Lin Xu and Ning Li*. "Early versus delayed administration of norepinephrine in patients with septic shock". Critical Care. 2014. :.
PubMed PDF

Clinical Question

• In adult patients with septic shock have improved hospital mortality in patients who receive delayed norepinephrine?

Conclusion

• In patients with septic shock, early administration of norepinephrine is associated with increase survival rate

Major Points

• Overall mortality of septic shock patients is 37.6%
• Delaying norepinephrine even if given within 6 hours by 1 hour was associated with an increase in mortality by 5.3%
• norepinephrine increases preload, improves cardiac output and renal perfusion

Study Design

• Retrospective cohort study from Jan 2011 to December 2012
• 2 general surgical intensive care units at a tertiary care hospital
• Septic shock is defined as presence of infection with hypotension SBP<90 mmHg, decrease of 40 mmHg in SBP from patients baseline MAP or MAP<65;

Outcomes

Primary Outcome

*28 day mortality

• improved outcomes when norepinephrine was delivered within 2 hours of septic shock onset compared to more than 2 hours
• Patients with early NE had improved MAPs, and lower lactates with less amount of time hypotensive and with fewer amounts of NE given