Norepinephrine in septic shock

• Published in: Intensive care medicine Vol. 45; no. 5; pp. 687 - 689
• Main Authors: Hernández, Glenn, Teboul, Jean-Louis, Bakker, Jan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2019; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Anesthesiology; Catecholamines; Critical Care Medicine; Drug therapy; Emergency Medicine; Human health and pathology; Humans; Intensive; Intensive care; Life Sciences; Medicine; Medicine & Public Health; Noradrenaline; Norepinephrine; Norepinephrine - pharmacokinetics; Norepinephrine - pharmacology; Norepinephrine - therapeutic use; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Pulmonology and respiratory tract; Sepsis; Septic shock; Shock, Septic - drug therapy; Shock, Septic - physiopathology; Time Factors; Vasoconstrictor Agents - pharmacokinetics; Vasoconstrictor Agents - pharmacology; Vasoconstrictor Agents - therapeutic use; What's New in Intensive Care; France
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-018-5499-8

Norepinephrine (NE) is both an alpha1- and beta1-agonist, and is therefore able to increase vascular tone and contractility [1]. Recent guidelines recommend NE as the frst-line vasopressor in septic shock [2]. However, because septic shock is a syndrome that results from a variable combination of decreased venous return, myocardial depression and decreased vascular tone, the place for NE in initial resuscitation is not straightforward. There is no doubt that prolonged hypotension contributes to the mortality of sepsis [3], but several issues, such as when to start NE, or the optimal mean arterial pressure (MAP) target in different contexts, are still controversial [4]. This is particularly relevant since NE has a wide spectrum of effects on the cardiovascular system (Fig. 1) that could eventually increase or decrease systemic, regional or microcirculatory blood flow depending on factors such as dose, pre-existing comorbidities, preload status, severity and stage of disease, and interaction with other processes of care [1].