How is norepinephrine used in the treatment of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Norepinephrine is a potent alpha-adrenergic agonist with minimal beta-adrenergic agonist effects. It can increase blood pressure successfully in patients with sepsis who remain hypotensive after fluid resuscitation and dopamine. The dosage may range from 0.2 to 1.5 µg/kg/min, and dosages as high as 3.3 µg/kg/min have been used because of the alpha-receptor downregulation in sepsis.

In patients with sepsis, indices of regional perfusion (eg, urine flow) and lactate concentration have improved after norepinephrine infusion. Several studies have found that a significantly greater percentage of patients treated with norepinephrine were resuscitated successfully, in comparison with patients treated with dopamine. [88, 89] Therefore, norepinephrine should be used early and should not be withheld as a last resort in patients with sepsis who are in shock.

Concerns about compromising splanchnic tissue oxygenation have not been borne out by the data; the studies have confirmed no deleterious effects on splanchnic oxygen consumption and hepatic glucose production, provided that adequate cardiac output is maintained.


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