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Comparison of Early Norepinephrine Administration Versus Standard Treatment in Patients With Septic Shock

Nida Zahra1, Fazil Hussain2, Ali Mehdi3, Reena Wafa4, Muhammad Saqlain5, Asiya 6
1Postgraduate resident, Provincial Headquarters Teaching Hospital, Gilgit
2Senior Consultant Medical Specialist/Supervisor, PHQ Teaching Hospital, Gilgit
3Post Graduate Resident, PHQ Hospital, Gilgit
4Post Graduate Medicine and Allied PHQ Hospital Teaching Hospital Gilgit
5PGR, PHQ Hospital Gilgit
6PGR PHQ Hospital, Gilgit
DOI: https://doi.org/10.70517/revcc2624137
Published: 07/10/2026
: Nida Zahra, Fazil Hussain, Ali Mehdi, Reena Wafa, Muhammad Saqlain, Asiya. Comparison of Early Norepinephrine Administration Versus Standard Treatment in Patients With Septic Shock. Revista Cultura Científica, 2026 Issue 24. pg. 1658-1666.

Abstract

Septic shock is a life-threatening condition characterized by profound circulatory dysfunction and persistent hypotension, requiring rapid hemodynamic stabilization. The objective of this study was to compare the effectiveness of early norepinephrine administration with standard treatment in achieving shock control among patients with septic shock. A randomized controlled trial was conducted in the Department of Medicine, Provincial Headquarter Hospital, Gilgit, from May 2026 to August 2026. A total of 106 patients aged 18–65 years with septic shock were enrolled through non-probability consecutive sampling and randomly allocated equally to an early norepinephrine group and a standard-treatment group, with 53 patients in each group. Both groups received standard septic shock management, including crystalloid resuscitation, antibiotics, source control, and organ support. The mean age was 49.1 ± 11.8 years in the early norepinephrine group and 50.4 ± 12.2 years in the standard-treatment group (p = 0.578). Baseline mean arterial pressure was also comparable between the groups (56.7 ± 5.8 vs. 57.4 ± 6.1 mmHg; p = 0.546). Shock control was achieved in 40 (75.5%) patients receiving early norepinephrine compared with 26 (49.1%) patients receiving standard treatment (χ2 = 7.88, p = 0.005). Mean arterial pressure at 1 hour was significantly higher in the early norepinephrine group (68.9 ± 7.0 vs. 63.2 ± 7.6 mmHg; p < 0.001), with significant differences persisting at 6 hours (73.8 ± 6.6 vs. 68.5 ± 7.4 mmHg; p < 0.001) and 24 hours (76.1 ± 7.1 vs. 71.9 ± 7.8 mmHg; p = 0.005). These findings indicate that early norepinephrine administration was more effective than standard treatment in achieving shock control and produced a more rapid improvement in mean arterial pressure among patients with septic shock.

Keywords: septic shock, norepinephrine, vasopressor, shock control, mean arterial pressure, hemodynamic stabilization

Abstract

Septic shock is a life-threatening condition characterized by profound circulatory dysfunction and persistent hypotension, requiring rapid hemodynamic stabilization. The objective of this study was to compare the effectiveness of early norepinephrine administration with standard treatment in achieving shock control among patients with septic shock. A randomized controlled trial was conducted in the Department of Medicine, Provincial Headquarter Hospital, Gilgit, from May 2026 to August 2026. A total of 106 patients aged 18–65 years with septic shock were enrolled through non-probability consecutive sampling and randomly allocated equally to an early norepinephrine group and a standard-treatment group, with 53 patients in each group. Both groups received standard septic shock management, including crystalloid resuscitation, antibiotics, source control, and organ support. The mean age was 49.1 ± 11.8 years in the early norepinephrine group and 50.4 ± 12.2 years in the standard-treatment group (p = 0.578). Baseline mean arterial pressure was also comparable between the groups (56.7 ± 5.8 vs. 57.4 ± 6.1 mmHg; p = 0.546). Shock control was achieved in 40 (75.5%) patients receiving early norepinephrine compared with 26 (49.1%) patients receiving standard treatment (χ2 = 7.88, p = 0.005). Mean arterial pressure at 1 hour was significantly higher in the early norepinephrine group (68.9 ± 7.0 vs. 63.2 ± 7.6 mmHg; p < 0.001), with significant differences persisting at 6 hours (73.8 ± 6.6 vs. 68.5 ± 7.4 mmHg; p < 0.001) and 24 hours (76.1 ± 7.1 vs. 71.9 ± 7.8 mmHg; p = 0.005). These findings indicate that early norepinephrine administration was more effective than standard treatment in achieving shock control and produced a more rapid improvement in mean arterial pressure among patients with septic shock.

Keywords: septic shock, norepinephrine, vasopressor, shock control, mean arterial pressure, hemodynamic stabilization

References

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  2. Shi, Rui, Olfa Hamzaoui, Nello De Vita, Xavier Monnet, and Jean-Louis Teboul. “Vasopressors in Septic Shock: Which, When, and How Much?” Annals of Translational Medicine, vol. 8, no. 12, 2020, article 794.

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  4. Xiang, Hui, et al. “Dose-Related Effects of Norepinephrine on Early-Stage Endotoxemic Shock in a Swine Model.” Journal of Intensive Medicine, vol. 3, no. 4, 2023, pp. 335–344.

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  8. Permpikul, Chairat, et al. “Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial.” American Journal of Respiratory and Critical Care Medicine, vol. 199, no. 9, 2019, pp. 1097–1105.

  9. Bai, Xiaowu, et al. “Early versus Delayed Administration of Norepinephrine in Patients with Septic Shock.” Critical Care, vol. 18, no. 5, 2014, article 532.

  10. Elbouhy, Mohamed A., Mohamed Soliman, Aymen Gaber, Khaled M. Taema, and Ahmed Abdel-Aziz. “Early Use of Norepinephrine Improves Survival in Septic Shock: Earlier than Early.” Archives of Medical Research, vol. 50, no. 6, 2019, pp. 325–332.

  11. Ospina-Tascón, Gustavo A., et al. “Effects of Very Early Start of Norepinephrine in Patients with Septic Shock: A Propensity Score-Based Analysis.” Critical Care, vol. 24, no. 1, 2020, article 52.

  12. Xu, Fei, Rong Zhong, Shanyang Shi, Yiqian Zeng, and Zhanhong Tang. “Early Initiation of Norepinephrine in Patients with Septic Shock: A Propensity Score-Based Analysis.” The American Journal of Emergency Medicine, vol. 54, 2022, pp. 287–296.

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  14. Maheshwari, Kamal, et al. “The Relationship between ICU Hypotension and In-Hospital Mortality and Morbidity in Septic Patients.” Intensive Care Medicine, vol. 44, no. 6, 2018, pp. 857–867.

  15. Hamzaoui, Olfa, et al. “Norepinephrine Exerts an Inotropic Effect during the Early Phase of Human Septic Shock.” British Journal of Anaesthesia, vol. 120, no. 3, 2018, pp. 517–524.

  16. Patel, Gourang P., et al. “Efficacy and Safety of Dopamine versus Norepinephrine in the Management of Septic Shock.” Shock, vol. 33, no. 4, 2010, pp. 375–380.

  17. Russell, James A., et al. “Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock.” The New England Journal of Medicine, vol. 358, no. 9, 2008, pp. 877–887.

  18. Delaney, Anthony, et al. “Initiation of Vasopressor Infusions via Peripheral versus Central Access in Patients with Early Septic Shock: A Retrospective Cohort Study.” Emergency Medicine Australasia, vol. 32, no. 2, 2020, pp. 210–219.

Nida Zahra
Postgraduate resident, Provincial Headquarters Teaching Hospital, Gilgit
nidazahra0912@gmail.com
Fazil Hussain
Senior Consultant Medical Specialist/Supervisor, PHQ Teaching Hospital, Gilgit
Ali Mehdi
Post Graduate Resident, PHQ Hospital, Gilgit
Reena Wafa
Post Graduate Medicine and Allied PHQ Hospital Teaching Hospital Gilgit
Muhammad Saqlain
PGR, PHQ Hospital Gilgit
Asiya
PGR PHQ Hospital, Gilgit

How to cite:

Nida Zahra, Fazil Hussain, Ali Mehdi, Reena Wafa, Muhammad Saqlain, Asiya. Comparison of Early Norepinephrine Administration Versus Standard Treatment in Patients With Septic Shock. Revista Cultura Científica, 2026 Issue 24. pg. 1658-1666.

Publication History

  • Received: 07/08/2026
  • Accepted: 01/10/2026
  • Published: 07/10/2026
Copyright © 2026, Nida Zahra, Fazil Hussain, Ali Mehdi, Reena Wafa, Muhammad Saqlain, Asiya. Published by Revista Cultura Científica. This article is published as open access under the Creative Commons Attribution 4.0 International (CC BY 4.0) license (http://creativecommons.org/licenses/by/4.0/).

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