Comparison of Earlier vs Early Start of Norepinephrine in Patients with Septic Shock

Abstract

Objective: To compare the effects of earlier Nor-epinephrine administration i.e. within 40 minutes of initial fluid administration with early Nor-epinephrine administration i.e. 80 minutes of fluid administration in terms of time required to achieve mean arterial pressure of greater 65 mm of Hg and volume of resuscitation fluid administered.

Methodology: This single blind randomized control trial was carried out at Department of Anesthesia and Critical Care Medicine from 1st January 2023-31st December 2023. Patients fulfilling the inclusion criteria i.e. age >18 years having septic shock with Mean arterial pressure of less than 65 mm of Hg requiring fluid resuscitation with vasopressor therapy were enrolled in the study and divided into two groups using computer generated random numbers. Group E patients received Nor-epinephrine infusion at 80 minutes while those belonging to group EL received Nor-epinephrine infusion at 40 minutes after initial fluid administration.

Results: Patients who received EL achieved MAP greater than equal to 65mm Hg earlier with median time of 60 minutes as compared to 80 minutes in group E with p value of 0.000. The median volume administered was significantly lower in group EL that was 2000 ml as compared to 2600 ml in group E with p value of 0.000.

Conclusion: Earlier administration of Nor-epinephrine results in restoration of MAP of 65 mm Hg and requires less amount of crystalloid fluid during volume resuscitation which can improve outcomes for patients with septic shock