title: Early versus delayed administration of norepinephrine in patients with septic shock.
abstract: BACKGROUND
  This study investigated the incidence of delayed norepinephrine administration following the onset of septic shock and its effect on hospital mortality.
  
  
  METHODS
  We conducted a retrospective cohort study using data from 213 adult septic shock patients treated at two general surgical intensive care units of a tertiary care hospital over a two year period. The primary outcome was 28-day mortality.
  
  
  RESULTS
  The 28-day mortality was 37.6% overall. Among the 213 patients, a strong relationship between delayed initial norepinephrine administration and 28-day mortality was noted. The average time to initial norepinephrine administration was 3.1 ± 2.5 hours. Every 1-hour delay in norepinephrine initiation during the first 6 hours after septic shock onset was associated with a 5.3% increase in mortality. Twenty-eight day mortality rates were significantly higher when norepinephrine administration was started more than or equal to 2 hours after septic shock onset (Late-NE) compared to less than 2 hours (Early-NE). Mean arterial pressures at 1, 2, 4, and 6 hours after septic shock onset were significantly higher and serum lactate levels at 2, 4, 6, and 8 hours were significantly lower in the Early-NE than the Late-NE group. The duration of hypotension and norepinephrine administration was significantly shorter and the quantity of norepinephrine administered in a 24-hour period was significantly less for the Early-NE group compared to the Late-NE group. The time to initial antimicrobial treatment was not significantly different between the Early-NE and Late-NE groups.
  
  
  CONCLUSIONS
  Our results show that early administration of norepinephrine in septic shock patients is associated with an increased survival rate.
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Bai
authors.forename: Wenkui
authors.initials: W
authors.lastname: Yu
authors.forename: Wu
authors.initials: W
authors.lastname: Ji
authors.forename: Zhiliang
authors.initials: Z
authors.lastname: Lin
authors.forename: Shanjun
authors.initials: S
authors.lastname: Tan
authors.forename: Kaipeng
authors.initials: K
authors.lastname: Duan
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.forename: Ning
authors.initials: N
authors.lastname: Li
mesh_terms: D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine