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March 18, 2024Intensive Care MedicineOpen Access

Knowing the ropes of vasopressor dosing: a focus on norepinephrine

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Key result

Norepinephrine remains first-line for shock but requires standardized dosing and titration practices.

Why the study?

Despite the ubiquitous use of norepinephrine as the first-line vasopressor for shock, clinical practice regarding its administration remains heterogeneous.

Design

Practical review article

Authors

EKEduardo KattanMIMiguel Ibarra‐EstradaCJChristian Jung

Discussion

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Overview

Should not yet change shock protocols; leaves open need for prospective validation of norepinephrine strategies.

Structured PICO

P
Population
Critically ill patients requiring vasopressors for shock
I
Intervention
Norepinephrine administration

This review provides practical guidance on the fundamentals of norepinephrine administration in critically ill patients with shock.

Limitations

  • Heterogeneity of practice on how to titrate the drug infusion
  • Significant worldwide variability on drug formulations
  • Uncertainties regarding optimal timing, dosing in special populations, and de-escalation

Cite This Study

Kattan et al. (2024) conducted an editorial in Shock. Norepinephrine was evaluated. Norepinephrine remains the first-line vasopressor for shock, but significant heterogeneity exists in its dosing, formulation, and titration targets, highlighting the need for standardized practices.

synapsesocial.com/papers/6aa95c24398b99bbe68cc63chttps://doi.org/10.1007/s00134-024-07374-y
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate- and high-risk surgery2019 · 47 citations
  2. 2Direct assessment of microcirculation in shock: a randomized-controlled multicenter study2023 · 101 citations
  3. 3Vasopressor Choice and Timing in Vasodilatory Shock2022 · 123 citations
  4. 4Position Paper on the Reporting of Norepinephrine Formulations in Critical Care from the Society of Critical Care Medicine and European Society of Intensive Care Medicine Joint Task Force2024 · 94 citations
  5. 5An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity2023 · 167 citations