EARLY NOREPINEPHRINE USE IN SEPTIC SHOCK: IMPACT ON HEMODYNAMIC RESUSCITATION AND CLINICAL OUTCOMES

Abstract

The early use of norepinephrine in the management of septic shock has been widely considered a strategy to improve clinical outcomes. This study aimed to analyze, in light of recent literature, the effects of early norepinephrine administration in septic shock on hemodynamic resuscitation and clinical outcomes. This is a literature search conducted in the PubMed, Virtual Health Library, and SciELO databases between 2016 and 2026. The analysis was thematic and included clinical trials, observational studies, propensity score analyses, systematic reviews, meta-analyses, and trial protocols; a total of 27 studies were included in the final synthesis. The results suggest that early initiation of norepinephrine is associated with improved shock control in the first hours, lower fluid volume administration, faster achievement of mean arterial pressure targets, and, in some analyses, reduced mortality. Mechanistic studies indicate that the drug may also enhance systolic function and the efficiency of resuscitation, while implementation studies demonstrate the feasibility of peripheral or midline administration in selected settings. Nevertheless, the evidence remains heterogeneous, with variability in the definition of early initiation and a strong influence of co-interventions. In conclusion, early norepinephrine use appears physiologically plausible and clinically promising, particularly when integrated with dynamic assessment of perfusion and fluid responsiveness. However, the decision should remain individualized, as the overall certainty of the evidence is not yet definitive.