Trial reportCritical care (London, England)2020
Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis.
Trial report in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07418541 (Early Co-Administration of 30 mL/kg Crystalloid Fluid and Norepinephrine for Preventing Acute Kidney Injury in Septic Shock), which is not on this map. Cited by 84 papers, 4 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.
Early Co-Administration of 30 mL/kg Crystalloid Fluid and Norepinephrine for Preventing Acute Kidney Injury in Septic Shock: A Pretest-Posttest Clinical Study
Who cites it
84 citing papers in PubMed, 4 syntheses or guidelines pooled it, 164 citations in OpenAlex.
- Early norepinephrine for patients with septic shock: an updated systematic review and meta-analysis with trial sequential analysis.Critical care (London, England) · 2025Pooled it
- Early management of adult sepsis and septic shock: Korean clinical practice guidelines.Acute and critical care · 2024Guideline
- Does Fluid Administration Based on Fluid Responsiveness Tests such as Passive Leg Raising Improve Outcomes in Sepsis?Current cardiology reviews · 2022Pooled it
- Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis.Critical care (London, England) · 2020Pooled it
- Hour-1 Sepsis Bundle: Updated Evidence.Journal of clinical medicine · 2026Review
- The Implementation Gap in Early Septic Shock Resuscitation: A Three-Barrier Framework.Journal of clinical medicine · 2026Article
- Incidence of intra-abdominal hypertension after liver transplantation with temporary portocaval shunt - A prospective cohort.Clinics (Sao Paulo, Brazil) · 2026Article
- Early inotropic support without fluid bolusWorld journal of clinical pediatrics · 2026Article
- The Physiology, Pathophysiology, and Clinical Implications of Fluid Resuscitation in Critically Ill Patients.Cureus · 2026Review
- Effect of norepinephrine on ventricular systolic function during septic shock: the ENESySS study.Journal of anesthesia, analgesia and critical care · 2026Article
- Temporal Analysis of Diastolic Shock Index in Patients with Septic Shock and Its Correlation with Clinical Outcomes in an Indian Setting: A Prospective Observational Study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Article
- Time-to-vasopressors and clinical outcome by level of diastolic blood pressure and pulse pressure in patients with septic shock: a retrospective analysis of prospective multicenter cohort study.Critical care (London, England) · 2026Article
- Effect of norepinephrine initiation timing on mortality in septic shock: a multicenter cohort study.BMC anesthesiology · 2026Observational
- Unnecessary fluid therapy in patients with shock: Five classic fluid pitfalls and five ways to do it better.Annals of intensive care · 2026Review
- Rethinking Fluid Resuscitation in Septic Shock: A Phase-Adapted, Endothelium-Sparing Approach to Mitigate Capillary Leak.Journal of inflammation research · 2026Article
- Early prediction of vasopressor initiation in ICU sepsis patients using an interpretable EHR-based ML model.BMC medical informatics and decision making · 2025Article
- Review
- A Novel Approach to Early Personalized Hemodynamic Resuscitation: Non-Invasive Peripheral Photoplethysmography for Identifying Predominant Vasodilatory Shock in Sepsis.Acta anaesthesiologica Scandinavica · 2025Article
- Summary of best evidence for safe management of vasopressors through peripheral intravenous catheters.BMC nursing · 2025Article
- Fluid management strategies in critically ill patients with ARDS: a narrative review.European journal of medical research · 2025Review
24 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
13 authors at 4 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOptimal timing for the start of vasopressors (VP) in septic shock has not been widely studied since it is assumed that fluids must be administered in advance. We sought to evaluate whether a very early start of VP, even without completing the initial fluid loading, might impact clinical outcomes in septic shock.
methodsA total of 337 patients with sepsis requiring VP support for at least 6 h were initially selected from a prospectively collected database in a 90-bed mixed-ICU during a 24-month period. They were classified into very-early (VE-VPs) or delayed vasopressor start (D-VPs) categories according to whether norepinephrine was initiated or not within/before the next hour of the first resuscitative fluid load. Then, VE-VPs (n = 93) patients were 1:1 propensity matched to D-VPs (n = 93) based on age; source of admission (emergency room, general wards, intensive care unit); chronic and acute comorbidities; and lactate, heart rate, systolic, and diastolic pressure at vasopressor start. A risk-adjusted Cox proportional hazard model was fitted to assess the association between VE-VPs and day 28 mortality. Finally, a sensitivity analysis was performed also including those patients requiring VP support for less than 6 h.
resultsPatients subjected to VE-VPs received significantly less resuscitation fluids at vasopressor starting (0[0-510] vs. 1500[650-2300] mL, p < 0.001) and during the first 8 h of resuscitation (1100[500-1900] vs. 2600[1600-3800] mL, p < 0.001), with no significant increase in acute renal failure and/or renal replacement therapy requirements. VE-VPs was related with significant lower net fluid balances 8 and 24 h after VPs. VE-VPs was also associated with a significant reduction in the risk of death compared to D-VPs (HR 0.31, CI95% 0.17-0.57, p < 0.001) at day 28. Such association was maintained after including patients receiving vasopressors for < 6 h.
conclusionA very early start of vasopressor support seems to be safe, might limit the amount of fluids to resuscitate septic shock, and could lead to better clinical outcomes.
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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.