- For patients with septic shock, early norepinephrine during resuscitation resulted in better short-term shock control but no improvement in mortality as a secondary outcome.
- Larger trials are needed.
Why this matters
- Despite promising retrospective studies, few prospective data were previously available to support this intervention.
- Patients randomly assigned earlier than in 3 previous studies of early goal-directed therapy (ProCESS, ARISE, and ProMISe), according to authors.
- Median time from emergency department arrival to norepinephrine: 93 minutes.
- Norepinephrine vs standard treatment (95% CIs):
- Shock control: 76.1% vs 48.4%; OR, 3.4 (2.09-5.53); P<.001.>
- 28-day mortality: 15.5% vs 21.9%; relative risk, 0.79 (0.53-1.11); P=.15.
- No differences in respiratory failure requiring ventilator support, renal failure requiring renal replacement therapy, organ support-free days, or limb or intestinal ischemia.
- Single-center randomized controlled double-masked CENSER trial (n=310).
- Adults with sepsis and hypotension randomly assigned to early norepinephrine vs standard treatment (2012 Surviving Sepsis guidelines).
- Outcome: shock control at 6 hours.
- Funding: Siriraj Critical Care Research Funding (Bangkok, Thailand).
- Single-center trial.
- Fluid rates were not controlled.
- Primary outcome was not patient-centered.
- Many patients had to be managed on the ward, not the ICU.