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?


  • 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 [1]

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;


Patient Demographics

Inclusion Criteria

Exclusion Criteria



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

Secondary Outcomes

Subgroup analysis

Criticisms & Further Discussion

External Links

See Also