EARLY USE OF NOREPINEPHRINE IN SEPSIS: HEMODYNAMIC IMPACT AND MORTALITY REDUCTION

Abstract

Sepsis and septic shock are major causes of morbidity and mortality among critically ill patients, with hemodynamic instability being one of the main factors associated with poor outcomes. In this context, norepinephrine is recommended as the first-line vasopressor for maintaining tissue perfusion and mean arterial pressure. However, the optimal timing for initiating vasopressor therapy remains controversial. This study aimed to analyze the scientific evidence regarding the impact of early norepinephrine administration on hemodynamic parameters and mortality in patients with sepsis and septic shock. An integrative literature review was conducted using PubMed/MEDLINE, Embase, Scopus, and the Virtual Health Library (VHL), including studies published between January 2019 and May 2026. Primary studies evaluating early norepinephrine administration in adult patients with sepsis or septic shock were included. The final sample consisted of five studies, including two randomized clinical trials and three observational studies. The findings demonstrated that early norepinephrine administration was associated with faster achievement of target mean arterial pressure, reduced fluid requirements, improved tissue perfusion markers, and lower 28-day mortality. However, conflicting results remained regarding long-term outcomes, particularly 90-day mortality. It is concluded that early norepinephrine administration represents a promising strategy for optimizing hemodynamic resuscitation in patients with septic shock and may contribute to improved clinical outcomes, although further studies are needed to define the optimal timing for vasopressor initiation.