Trial reportCritical care (London, England)2009
Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: a prospective study.
Trial report in Critical care (London, England), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 8 registered trials, which are not on this map. Cited by 161 papers.
What it found
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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.
High Mean Arterial Pressure Target Improves Microcirculation in Septic Shock Patients With Previous Hypertension
Microcirculation After MAP Increase in Septic Shock Patients With Previous Hypertension
Influence of Vasopressors on Brain Oxygenation and Microcirculation in Anesthetized Patients With Cerebral Tumors
Early Goal Directed Therapy Using a Physiological Holistic View. A Multicenter Study in Latin America: The ANDROMEDA-SHOCK Study
Vasopressin or Norepinephrine in Vasoplegic Shock After Non-cardiac Surgery: a Randomized and Controlled Trial
The Prognostic Value of Simultaneous Assessment of Microcirculation Alteration With Sublingual Microcirculation and Near-infrared Spectroscopy on the Acute Respiratory Distress Syndrome of Various Phenotypes
Influence of Vasopressor Support and Mean Arterial Pressure on Capillary Refill Time Values in Critically Ill Patients: Prospective, Observational Study
Effect of Vasopressin on Kidney and Cardiac Function in Previously Hypertensive Patients With Septic Shock: A Randomized Clinical Trial
Who cites it
161 citing papers in PubMed, 463 citations in OpenAlex.
- Direct assessment of microcirculation in shock: a randomized-controlled multicenter study.Intensive care medicine · 2023Trial
- Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis.Critical care (London, England) · 2020Trial
- Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline.Clinics (Sao Paulo, Brazil) · 2017Trial
- Trial
- Sedation and renal impairment in critically ill patients: a post hoc analysis of a randomized trial.Critical care (London, England) · 2011Trial
- Effects of vasopressinergic receptor agonists on sublingual microcirculation in norepinephrine-dependent septic shock.Critical care (London, England) · 2011Trial
- Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: a randomised controlled trial.Critical care (London, England) · 2010Trial
- Diffuse Correlation Spectroscopy for Noninvasive Monitoring of Peripheral Perfusion During Cardiogenic Shock and VA-ECMO Support: An Experimental Study.Shock (Augusta, Ga.) · 2026Article
- Twenty-five years of septic shock hemodynamic resuscitation trials: a conceptual perspective.Critical care (London, England) · 2026Review
- Beyond shear stress: septic microvascular failure remains a multifactorial phenomenon.Critical care (London, England) · 2026Article
- High vasopressor doses are associated with decreased tissue oxygenation in critically ill patients: a secondary analysis of a prospective cohort.Critical care (London, England) · 2026Article
- Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion.Acute and critical care · 2026Article
- The Physiology, Pathophysiology, and Clinical Implications of Fluid Resuscitation in Critically Ill Patients.Cureus · 2026Review
- Proof of concept of noninvasive detection of norepinephrine induced stroke volume changes using perfusion index in cardiac surgery.Scientific reports · 2026Observational
- Changes in microcirculation variables in an acute endotoxaemic equine model.Equine veterinary journal · 2025Article
- Identification of intraoperative hypotension endotypes and revolution with a temporal deep learning algorithm.Perioperative medicine (London, England) · 2025Article
- The intricate relationship between capillary refill time and systemic hemodynamics in septic shock.Annals of intensive care · 2025Review
- Cardiogenic shock: diagnosis, phenotyping and management.Intensive care medicine · 2025Review
- Vasopressin and its analogues in patients with septic shock: holy Grail or unfulfilled promise?Critical care (London, England) · 2025Review
- Evaluation of Systemic Microcirculatory Vessel Density in the Early Postoperative Period of Heart Valve Surgery: an Observational Study.Brazilian journal of cardiovascular surgery · 2025Observational
101 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionOur goal was to assess the effects of titration of a norepinephrine infusion to increasing levels of mean arterial pressure (MAP) on sublingual microcirculation.
methodsTwenty septic shock patients were prospectively studied in two teaching intensive care units. The patients were mechanically ventilated and required norepinephrine to maintain a mean arterial pressure (MAP) of 65 mmHg. We measured systemic hemodynamics, oxygen transport and consumption (DO2 and VO2), lactate, albumin-corrected anion gap, and gastric intramucosal-arterial PCO2 difference (DeltaPCO2). Sublingual microcirculation was evaluated by sidestream darkfield (SDF) imaging. After basal measurements at a MAP of 65 mmHg, norepinephrine was titrated to reach a MAP of 75 mmHg, and then to 85 mmHg. Data were analyzed using repeated measurements ANOVA and Dunnett test. Linear trends between the different variables and increasing levels of MAP were calculated.
resultsIncreasing doses of norepinephrine reached the target values of MAP. The cardiac index, pulmonary pressures, systemic vascular resistance, and left and right ventricular stroke work indexes increased as norepinephrine infusion was augmented. Heart rate, DO2 and VO2, lactate, albumin-corrected anion gap, and DeltaPCO2 remained unchanged. There were no changes in sublingual capillary microvascular flow index (2.1 +/- 0.7, 2.2 +/- 0.7, 2.0 +/- 0.8) and the percent of perfused capillaries (72 +/- 26, 71 +/- 27, 67 +/- 32%) for MAP values of 65, 75, and 85 mmHg, respectively. There was, however, a trend to decreased capillary perfused density (18 +/- 10,17 +/- 10,14 +/- 2 vessels/mm2, respectively, ANOVA P = 0.09, linear trend P = 0.045). In addition, the changes of perfused capillary density at increasing MAP were inversely correlated with the basal perfused capillary density (R2 = 0.95, P < 0.0001).
conclusionsPatients with septic shock showed severe sublingual microcirculatory alterations that failed to improve with the increases in MAP with norepinephrine. Nevertheless, there was a considerable interindividual variation. Our results suggest that the increase in MAP above 65 mmHg is not an adequate approach to improve microcirculatory perfusion and might be harmful in some 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.