title: Should the norepinephrine maximal dosage rate be greatly increased in late shock?
abstract: Any advanced shock eventually degenerates into vasoplegia, which responds weakly to vasopressors. The highest reported norepinephrine flow rate is 3 μg/kg/min. We present the case of a young explosion victim, who was transferred in late haemorrhagic shock. Apart from usual treatment (hydration, mass transfusion protocol), single-agent norepinephrine was used to maintain a mean arterial pressure (MAP) of >60-65 mm Hg. For several hours, norepinephrine flow was 7-10 times the aforementioned (highest reported) in order to achieve our goal; during which, further hydration or transfusion would not contribute to MAP elevation. Sequential Organ Failure Assessment (SOFA) severity score was 18 (expected mortality >99%). The patient survived without underperfusion-related damage. We conclude that norepinephrine dosages could potentially be greatly increased in late shock. We must resist giving up flow escalation based on its numerical value.
authors.affiliation: Limassol General Hospital, Limassol, Cyprus.
authors.forename: Christos
authors.identifier: http://orcid.org/0000-0003-1258-857X
authors.initials: C
authors.lastname: Stefanou
authors.affiliation: Limassol General Hospital, Limassol, Cyprus.
authors.forename: Lakis
authors.initials: L
authors.lastname: Palazis
authors.affiliation: Limassol General Hospital, Limassol, Cyprus.
authors.forename: Areti
authors.initials: A
authors.lastname: Loizou
authors.affiliation: Limassol General Hospital, Limassol, Cyprus.
authors.forename: Chrystalla
authors.initials: C
authors.lastname: Timiliotou
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D006801:Humans; D008297:Male; D009638:Norepinephrine / Q000008:administration & dosage*; D012769:Shock / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine