The impact of early norepinephrine administration on outcomes of patients with sepsis induced hypotension, randomized controlled prospective study

Abstract

Background: Hypovolemia and reduced vascular tone have a role in determining the severity of hypotension in septic shock. The risk of fluid overload is presented as common complication during septic shock resuscitation. The study aimed to investigate the effect of early norepinephrine administration on outcomes of patients with sepsis induced hypotension. Methods: This study was performed on 64 patients diagnosed with sepsis. The patients were randomly allocated into two groups, Group A: Received 30ml /kg ringer's lactate solution after first presentation then norepinephrine was added when persistent mean arterial pressure was still lower than mmHg despite adequate fluid resuscitation. Group B: Received 30ml /kg ringer's lactate solution after first presentation combined with norepinephrine infusion (0.05 mic/kg/min). Results: Time to reach MAP ≥ 65 mmHg showed statistically significant decrease in group B compared with group A. Mean arterial blood pressure in group B Showed statistically significant increase compared with group A. In group B: there were statistically significant decrease in heart rate changes compared with group A. There was statistically significant decrease in group B compared with group A in volume of intravenous fluid administered, quantity and dose of norepinephrine during 1st day, duration of norepinephrine, total leukocyte count, blood urea, serum creatinine and serum lactate and 30 days mortality. Urine output showed statistically significant increase in group B compared with group A at 1h, 6h, 12h and 24h follow up. Conclusion : Norepinephrine as part of initial resuscitation of sepsis induced hypotension result in decreased time to reach target MAP, decrease IV fluid requirement, lowers blood lactate levels, and decreases mortality rate.