Norepinephrine in septic shock

  • Glenn HernándezEmail author
  • Jean-Louis Teboul
  • Jan Bakker
What's New in Intensive Care


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 first-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...


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Conflict of interest

The authors declare no conflict of interest.


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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Departmento de Medicina Intensiva, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
  2. 2.Service de réanimation médicale, Hopital BicetreHopitaux Universitaires Paris-SudParisFrance
  3. 3.Assistance Publique Hôpitaux de ParisUniversité Paris-SudParisFrance
  4. 4.Department of Intensive Care AdultsErasmus MC University Medical CenterRotterdamThe Netherlands
  5. 5.Department of Pulmonary and Critical CareNew York UniversityNew YorkUSA
  6. 6.Division of Pulmonary, Allergy, and Critical Care MedicineColumbia University Medical CenterNew YorkUSA

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