Norepinephrine dosing in France: Time to move forward!

Abstract

Norepinephrine is the first-line vasopressor used in acute cardio-circulatory failure. At the bedside, its dose is critical as it serves to determine the severity of patients, to compare the patients between different studies, and to start specific interventions. Recently, several investigators underlined differences in the expression of norepinephrine doses according to countries and manufacturers. For various reasons, all norepinephrine products are processed to a salt formulation thereby generating a stable and soluble conjugated acid in a slightly acidic solution. Depending on the salt used, the total weight will differ, but the weight of pure norepinephrine base is the same. This results in at-risk situations with large variations in terms of practices, evaluation and treatment. In this technical note, we summarized the evidence and provided a few suggestions to improve the practices at different levels.