• Hiroshi Morimatsu, Kulgit Singh, Shigehiko Uchino, Rinaldo Bellomo, and Graeme Hart.
• Department of Intensive Care and Department of Medicine, Austin and Repatriation Medical Centre, Melbourne, Australia.
• Resuscitation. 2004 Aug 1;62(2):249-54.

BackgroundThe timing and use of norepinephrine (noradrenaline) (NE) in septic shock remain a matter of controversy.AimTo study the outcome of septic patients treated with early and exclusive NE.SettingTertiary Intensive Care Unit.Patients142 patients with septic shock.InterventionExclusive NE infusion within 24 hours of admission to ICU.Methods And Main ResultsRetrospective analysis of data from a unit database identified 142 patients. Their median admission simplified acute physiology score (SAPS II) score was 46 [38, 56] with 98 (69%) receiving mechanical ventilation. Mean arterial pressure (MAP) at the start of NE infusion was 60 [58, 68]mmHg. NE infusion was started at a median of 1.3 [0.3, 5.0]h after ICU admission. Restoration and maintenance of target MAP was achieved initially in all patients and, in 61.3%, within 30 min. The median peak dose of NE was 0.28 [0.14, 0.61]microg/(kg min) and the duration of infusion was 88 [42, 175]h. SAPS II predicted mortality was 40.8%, however, only 34.5% (P = 0.27) died. Among the most severely ill patients (SAPS II score >56) actual mortality was 50.0% versus 74.7% predicted (P = 0.07).ConclusionsEarly and exclusive use of NE in hyperdynamic septic shock achieved a stable MAP >75 mmHg in all patients. Survival compared favorably with that predicted by illness severity scores.

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