What is the role of norepinephrine in the management of multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH, FACP, FCCP, FCCM; 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 successfully increase blood pressure in patients who are in a septic state and remain hypotensive after fluid resuscitation and dopamine. Doses range from 0.2-1.35 µg/kg/min; doses as high as 3.3 µg/kg/min have been used because alpha-receptor down-regulation may occur in sepsis.

In patients with sepsis, indices of regional perfusion (eg, urine flow and lactate concentration) have improved after norepinephrine infusion. In recent controlled trials, no significant difference was noted in the rate of death between patients with shock who were treated with dopamine and those who were treated with norepinephrine; the use of dopamine was associated with a greater number of adverse events, which were mostly cardiac arrhythmias. [21, 22]

Accordingly, use norepinephrine early, and do not withhold it as a last resort. Norepinephrine therapy appears to have no effects on splanchnic oxygen consumption and hepatic glucose production, provided adequate cardiac output is maintained.


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