Clinical trial NCT05774054: The Impact of Early Norepinephrine Administration on Outcomes of Patients With Sepsis-induced Hypotension
Official title: The Impact of Early Norepinephrine Administration on Outcomes of Patients With Sepsis-induced Hypotension
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Norepinephrine
Sepsis
Hypotension
Lead sponsor: Tanta University
Sponsor class: OTHER
First posted: 2023-03-17
Enrollment: 64
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Septic shock is defined as sepsis with persistent hypotension requiring vasopressors to maintain mean arterial pressure (MAP)≥ 65 mmHg and a serum lactate level of \> 2 mmol/L (18 mg/dL) despite sufficient volume resuscitation

. Hypovolemia (both relative and absolute) and reduced vascular tone have a role in determining the severity of hypotension in septic shock

Detailed description: Septic shock is defined as sepsis with persistent hypotension requiring vasopressors to maintain mean arterial pressure (MAP)≥ 65 mmHg and a serum lactate level of \> 2 mmol/L (18 mg/dL) despite sufficient volume resuscitation . Hypovolemia (both relative and absolute) and reduced vascular tone have a role in determining the severity of hypotension in septic shock

. When mean arterial pressure (MAP) falls below a specific critical level organ blood flow is physiologically dependent on perfusion pressure. Fluid resuscitation and vasopressors have an influence on hypovolemia and the vascular tone in the early phase, as fluid resuscitation aims to correct hypovolemia and vasopressors-norepinephrine (NE)- as a first-line drug aiming to restore vascular tone to assure organ perfusion

. Norepinephrine is both an alpha1- and beta1-agonist so it is able to increase vascular tone and contractility

. Nevertheless, a large amount of fluids will increase the risk of fluid overload, which is a common complication during septic shock resuscitation

* After the early phase, only fifty percent of patients respond to fluid administration, meaning that fluid treatment cannot boost cardiac output (CO) The current data indicate that the time from the onset of septic shock to the initiation of norepinephrine administration is a significant survival predictor; however, a suggestion for the optimal time to provide norepinephrine support was not explicitly expressed

Eligibility criteria: Inclusion Criteria:

* Adult patients aged from18 to 65 years old
* had the diagnostic criteria for sepsis as the presence of infection
* systemic manifestations of infection and signs of Hypoperfusion

Exclusion Criteria:

* Acute cerebral vascular event
* Active cardiac conditions
* Valvular heart diseases
* Hypotension suspected to be due to another cause and comorbidities
* Status asthmatics
* Active hemorrhage
* Pregnancy
* Burn injury
* Requirement for immediate surgery
* Advanced-stage cancer
* Refusal to participate in the study

Primary outcomes:
measure: the required duration to achieve the target MAP
timeFrame: 24 hours since the diagnosis of sepsis
Secondary outcomes:
Other outcomes:
Locations:
city: Tanta
country: Egypt
facility: Faculty of medicine, Tanta university
state: El Gharbyia
Study officials:
affiliation: tanta university, faculty of medicine
name: ghada elbarady, MD
role: STUDY_DIRECTOR
References: