Early norepinephrine for patients with septic shock: an updated systematic review and meta-analysis with trial sequential analysis
Authors' conclusion
Early norepinephrine introduction in septic shock is associated with reduced mortality, decreased fluid volume administered at 6 h, faster time to achieve MAP target and more mechanical ventilation-free days.
Study context
- Population
- Adults with septic shock
- Participants
- 4,767 adults · 10 studies
- Comparison
- Early vs non-early norepinephrine initiation
- Outcome
- ICU mortality
Methodological detailstrial sequential analysis, random-effect model, subgroup analysis
- Trial sequential analysis
- Random-effect model
- Subgroup analysis
Pooled result
As reported in the abstract
Early vs Non-earlyOdds ratio (95% CI)P value
RCT; I2 = 45%
0.49(0.25–0.96)
P = 0.04Pooled RCT and PSM; I2 = 74%
0.65(0.42–0.99)
P = 0.05Observational studies; I2 = 66%
0.71(0.54–0.94)
Further pooled results
| Outcome | Mean difference (mL) (95% CI) | P value | |
|---|---|---|---|
| Fluid volume received · 6 hRCT + PSM; I2 = 91% | −502 (−899 to −106) | P = 0.01 | |
| −1000−5000500Difference, mL (linear scale) |
| Outcome | Mean difference (h) (95% CI) | P value | |
|---|---|---|---|
| Time to MAP targetRCT + PSM; I2 = 0% | −1.30 (−1.75 to −0.85) | P < 0.01 | |
| −2−101Difference, h (linear scale) |
| Outcome | Mean difference (days) (95% CI) | P value | |
|---|---|---|---|
| Mechanical ventilation-free daysRCT + PSM; I2 = 32% | 3.99 (2.42–5.57) | P < 0.01 | |
| −50510Difference, days (linear scale) |
| Outcome | Mean difference (mcg/kg) (95% CI) | P value | |
|---|---|---|---|
| Cumulative norepinephrine doseObservational; I2 = 0% | −3.44 (−6.13 to −0.76) | P = 0.01 | |
| −10−505Difference, mcg/kg (linear scale) |
ICU mortality by subgroup (lactate ≤ 3mmol/L; administered within 1 h)
- Reduced mortality with early norepinephrine when lactate was ≤ 3mmol/L and administered within 1 h
Original publication
Early norepinephrine for patients with septic shock: an updated systematic review and meta-analysis with trial sequential analysis. Crit Care. Published 6 May 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →