• Olfa Hamzaoui.
• aHôpitaux universitaires Paris-Sud, Hôpital Antoine Béclère, service de réanimation polyvalente, Clamart, France bDepartment of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands cHôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale dINSERM UMR S_999, Univ Paris-Sud, Le Kremlin-Bicêtre, France.
• Curr Opin Crit Care. 2017 Aug 1; 23 (4): 342-347.

Purpose Of ReviewNorepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension when high doses of norepinephrine are required to reach the target.Recent FindingsRecent literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoids fluid overload. Recent data are in favor of targeting a mean arterial pressure of at least 65 mmHg and higher values in case of chronic hypertension. When hypotension is refractory to norepinephrine, it is recommended adding vasopressin, which is relatively deficient during sepsis and acts on other vascular receptors than α1-adernergic receptors. However, increasing the dose of norepinephrine further cannot be discouraged.SummaryEarly administration of norepinephrine is beneficial for septic shock patients to restore organ perfusion. The mean arterial pressure target should be individualized. Adding vasopressin is recommended in case of shock refractory to norepinephrine.

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