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. 2021 Mar 31:13:143-150.
doi: 10.2147/OAEM.S298315. eCollection 2021.

Association Between Early Administration of Norepinephrine in Septic Shock and Survival

Mohammed S Alshahrani  1 , Rawan Alatigue  2
Affiliations

Association Between Early Administration of Norepinephrine in Septic Shock and Survival

Mohammed S Alshahrani et al. Open Access Emerg Med. .

Abstract

Introduction: Septic shock still carries a high mortality rate despite all advances in emergency and critical care practices. Early interventions have been proven in many aspects to improve outcome. However, early administration of vasopressors namely norepinephrine in septic shock is still controversial.

Objective: To identify the association between early norepinephrine administration and mortality in septic shock patients.

Methods: A retrospective review of a prospectively collected ICU data for septic shock patients in medical and surgical intensive care units for one year period was carried out. Case definition was based on sepsis 3 definitions. Data included patients' characteristics of demographics, admission diagnosis, APACHE II score, physiological data (including vital signs and laboratory values). The primary outcome was 28 days of mortality.

Results: A total of 243 patients identified during the study period, 132 (54.3%) were male. The mean age was found to be 58.9 ± 20.3. The overall rate of 28 days mortality was 87 (47.5%). Norepinephrine was started for 68.9% of the patients in ICU, the rest were started in the emergency department. The highest survival rates were among patients who received norepinephrine within first hour (58.1%) and second (51.5%). A binary logistic regression analysis has been performed to adjust for possible confounders. It was revealed that being intubated and mechanically ventilated or having higher APACHE II score were strongly associated with non-survival rates (OR=7.049, p-0.002), (OR=1.124, p-<0.001) respectively.

Conclusion: Our results showed that septic shock patients who had early administration of norepinephrine had a higher survival rate. Intubation and invasive ventilation and higher APACHE II score associated with higher none survival rate.

Keywords: antibacterial agents; sepsis; septic shock.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Mortality rate of patients whose initial norepinephrine administration were within the indicated time interval (hours).
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References

    1. Rahnema A, Jones J. Early use of norepinephrine in septic shock resuscitation (CENSER): a randomized trial. J Emerg Med. 2019;56(6):729–730. doi:10.1016/j.jemermed.2019.05.004 - DOI - PubMed
    1. Russell J, Lee T, Singer J, De Backer D, Annane D. Days alive and free as an alternative to a mortality outcome in pivotal vasopressor and septic shock trials. J Crit Care. 2018;47:333–337. doi:10.1016/j.jcrc.2018.05.003 - DOI - PubMed
    1. Maheshwari K, Nathanson B, Munson S, et al. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Intensive Care Med. 2018;44(6):857–867. doi:10.1007/s00134-018-5218-5 - DOI - PMC - PubMed
    1. Rowan K, Angus D, Bailey M, Barnato A. Early, goal-directed therapy for septic shock—a patient-level meta-analysis. N Engl J Med. 2017;376(23):2223–2234. - PubMed
    1. Watkins R, Haller N, Wayde M, Armitage K. A multicenter survey of house staff knowledge about sepsis and the “surviving sepsis campaign guidelines for management of severe sepsis and septic shock”. J Intensive Care Med. 2017;35(2):187–190. doi:10.1177/0885066617737304 - DOI - PubMed

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