Trial reportIntensive care medicine2008
A comparison of epinephrine and norepinephrine in critically ill patients.
Trial report in Intensive care medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 122 papers, 13 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
122 citing papers in PubMed, 13 syntheses or guidelines pooled it, 362 citations in OpenAlex.
- European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2025: post-resuscitation care.Intensive care medicine · 2025Guideline
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Application of norepinephrine in the treatment of septic shock: a meta-analysis.Irish journal of medical science · 2025Pooled it
- Early management of adult sepsis and septic shock: Korean clinical practice guidelines.Acute and critical care · 2024Guideline
- Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis.The western journal of emergency medicine · 2021Pooled it
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Comparative efficacy of vasoactive medications in patients with septic shock: a network meta-analysis of randomized controlled trials.Critical care (London, England) · 2019Pooled it
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Scandinavian SSAI clinical practice guideline on choice of first-line vasopressor for patients with acute circulatory failure.Acta anaesthesiologica Scandinavica · 2016Pooled it
- Vasopressors for hypotensive shock.The Cochrane database of systematic reviews · 2016Pooled it
- Pooled it
- Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.Intensive care medicine · 2013Guideline
- Pharmacologic agents for acute hemodynamic instability: recent advances in the management of perioperative shock- a systematic review.Annals of cardiac anaesthesiaPooled it
- Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study.Critical care (London, England) · 2014Trial
- A comparison of epinephrine and norepinephrine in critically ill patients.Intensive care medicine · 2008Trial
- Vasopressor Use Among Adults With Sepsis in Uganda and Rwanda: A Multicenter Retrospective Cohort Study.Critical care explorations · 2026Article
- Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN).Circulation. Heart failure · 2026Article
- Current and future strategies aiming at reducing catecholamine exposure in septic shock.Critical care (London, England) · 2026Review
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Vasoactive drug use in children with community acquired septic shock in Australia and New Zealand.The Lancet regional health. Western Pacific · 2026Article
62 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
7 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether there was a difference between epinephrine and norepinephrine in achieving a mean arterial pressure (MAP) goal in intensive care (ICU) patients.
designProspective, double-blind, randomised-controlled trial.
settingFour Australian university-affiliated multidisciplinary ICUs. PATIENTS AND
participantsPatients who required vasopressors for any cause at randomisation. Patients with septic shock and acute circulatory failure were analysed separately.
interventionsBlinded infusions of epinephrine or norepinephrine to achieve a MAP >or=70 mmHg for the duration of ICU admission. MEASUREMENTS: Primary outcome was achievement of MAP goal >24 h without vasopressors. Secondary outcomes were 28 and 90-day mortality. Two hundred and eighty patients were randomised to receive either epinephrine or norepinephrine. Median time to achieve the MAP goal was 35.1 h (interquartile range (IQR) 13.8-70.4 h) with epinephrine compared to 40.0 h (IQR 14.5-120 h) with norepinephrine (relative risk (RR) 0.88; 95% confidence interval (CI) 0.69-1.12; P = 0.26). There was no difference in the time to achieve MAP goals in the subgroups of patients with severe sepsis (n = 158; RR 0.81; 95% CI 0.59-1.12; P = 0.18) or those with acute circulatory failure (n = 192; RR 0.89; 95% CI 0.62-1.27; P = 0.49) between epinephrine and norepinephrine. Epinephrine was associated with the development of significant but transient metabolic effects that prompted the withdrawal of 18/139 (12.9%) patients from the study by attending clinicians. There was no difference in 28 and 90-day mortality.
conclusionsDespite the development of potential drug-related effects with epinephrine, there was no difference in the achievement of a MAP goal between epinephrine and norepinephrine in a heterogenous population of ICU patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.