Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jan 20;27(1):29.
doi: 10.1186/s13054-023-04322-y.

An updated "norepinephrine equivalent" score in intensive care as a marker of shock severity

Yuki Kotani  1   2   3 , Annamaria Di Gioia  1 , Giovanni Landoni  4   5 , Alessandro Belletti  1 , Ashish K Khanna  6   7
Affiliations
Review

An updated "norepinephrine equivalent" score in intensive care as a marker of shock severity

Yuki Kotani et al. Crit Care. .

Erratum in

Abstract

Vasopressors and fluids are the cornerstones for the treatment of shock. The current international guidelines on shock recommend norepinephrine as the first-line vasopressor and vasopressin as the second-line vasopressor. In clinical practice, due to drug availability, local practice variations, special settings, and ongoing research, several alternative vasoconstrictors and adjuncts are used in the absence of precise equivalent doses. Norepinephrine equivalence (NEE) is frequently used in clinical trials to overcome this heterogeneity and describe vasopressor support in a standardized manner. NEE quantifies the total amount of vasopressors, considering the potency of each such agent, which typically includes catecholamines, derivatives, and vasopressin. Intensive care studies use NEE as an eligibility criterion and also an outcome measure. On the other hand, NEE has several pitfalls which clinicians should know, important the lack of conversion of novel vasopressors such as angiotensin II and also adjuncts such as methylene blue, including a lack of high-quality data to support the equation and validate its predictive performance in all types of critical care practice. This review describes the history of NEE and suggests an updated formula incorporating novel vasopressors and adjuncts.

Keywords: Angiotensin II; Hemodynamic management; Methylene blue; Norepinephrine; Norepinephrine equivalence; Vasopressin; Vasopressor.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Visual summary of an updated norepinephrine equivalent score and need for using norepinephrine equivalence
See this image and copyright information in PMC

Comment in

References

    1. Mayr VD, Dünser MW, Greil V, Jochberger S, Luckner G, Ulmer H, Friesenecker BE, Takala J, Hasibeder WR. Causes of death and determinants of outcome in critically ill patients. Crit Care. 2006;10(6):R154. - PMC - PubMed
    1. Orban JC, Walrave Y, Mongardon N, Allaouchiche B, Argaud L, Aubrun F, Barjon G, Constantin JM, Dhonneur G, Durand-Gasselin J, et al. Causes and characteristics of death in intensive care units: a prospective multicenter study. Anesthesiology. 2017;126(5):882–9. - PubMed
    1. Wieruszewski PM, Khanna AK. Vasopressor choice and timing in vasodilatory shock. Crit Care. 2022;26(1):76. - PMC - PubMed
    1. Landry DW, Levin HR, Gallant EM, Ashton RC Jr, Seo S, D’Alessandro D, Oz MC, Oliver JA. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation. 1997;95(5):1122–5. - PubMed
    1. Mederle K, Schweda F, Kattler V, Doblinger E, Miyata K, Höcherl K, Oike Y, Castrop H. The angiotensin II AT1 receptor-associated protein Arap1 is involved in sepsis-induced hypotension. Crit Care. 2013;17(4):R130. - PMC - PubMed

MeSH terms