SynthesisCritical care (London, England)2025
Early norepinephrine for patients with septic shock: an updated systematic review and meta-analysis with trial sequential analysis.
Synthesis in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07453901 (The Multicentre Prospective Observational Study on the Management of Septic Shock), which is not on this map. Cited by 20 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.
The Multicentre Prospective Observational Study on the Management of Septic Shock (Observational Study on Septic Shock, the OSS Study)
Who cites it
20 citing papers in PubMed.
- [Vasopressors in septic shock: the old and the new].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Review
- [Vasopressors or fluids in early septic shock].Die Anaesthesiologie · 2026Article
- Efficacy of milrinone combined with norepinephrine in improving hemodynamics and protecting liver/kidney function in patients with septic shock.Pakistan journal of medical sciences · 2026Article
- A pilot study of the effect of norepinephrine dose on left ventricular-arterial coupling in patients with septic shock.Scientific reports · 2026Article
- Vasopressors or fluids for initial resuscitation in septic shock: A matter of clinical judgement.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Optimizing Timing and Dose of Starting Norepinephrine and Vasopressin in Septic Shock.Life (Basel, Switzerland) · 2026Review
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Care Pathway and Outcomes in Pediatric Septic Shock: A Narrative Review from Emergency Department Recognition to PICU Management.Children (Basel, Switzerland) · 2026Review
- SOFA-2 score predicts mortality in pneumonia-associated sepsis: a retrospective cohort study.Critical care (London, England) · 2026Article
- Clarithromycin for treating sepsis in adults.The Cochrane database of systematic reviews · 2026Article
- Implementation of a Sepsis Code Protocol at an Academic Institution in Colombia: A Pilot Study.Journal of clinical medicine · 2026Article
- Association between time to target mean arterial pressure and 90-day mortality in septic shock: a post hoc analysis of the OPTPRESS trial.Annals of intensive care · 2026Article
- Septic shock in the era of precision medicine: rethinking fluids, vasopressors, and immunomodulation.Frontiers in medicine · 2026Review
- The vasoactive-age adjusted sepsis-induced coagulopathy score predicts 28-day new-onset multiple organ dysfunction syndrome in patients with sepsis: a single-centre retrospective cohort study.Frontiers in medicine · 2026Article
- Unnecessary fluid therapy in patients with shock: Five classic fluid pitfalls and five ways to do it better.Annals of intensive care · 2026Review
- Current standard of care for septic shock.Intensive care medicine · 2026Review
- Review
- Article
- Norepinephrine Onset Time and Mortality in Patients with Septic Shock Treated in the Emergency Department.Journal of clinical medicine · 2025Article
- Summary of best evidence for safe management of vasopressors through peripheral intravenous catheters.BMC nursing · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal timing for initiating norepinephrine in septic shock is debated. This updated systematic review and meta-analysis aimed to evaluate the impact of early versus delayed norepinephrine initiation on mortality and clinical outcomes in adults with septic shock.
methodsA systematic search in Pubmed, EMbase and the Cochrane Library to identify eligible randomized controlled trials, propensity score matching (PSM) and observational studies that compare early norepinephrine initiation with non-early norepinephrine initiation in patients with acute circulatory failure. The primary outcome was mortality in intensive care unit. Secondary outcomes included intensive care unit length of stay, fluid volume received at 6 h, norepinephrine dose, mechanical ventilation-free days, renal replacement therapy free days, and time to achieve a targeted mean arterial pressure (MAP). Meta-analysis and subgroup analysis were conducted to calculate odds ratio (OR) or mean difference with 95% confidence interval (95%CI) using random-effect model. Trial sequential analysis was conducted to evaluate the conclusiveness of evidence.
resultsTen studies (two RCT, three PSM and five observational studies) involving 4767 patients were included. Early norepinephrine significantly reduced mortality in RCT (OR 0.49, 95%CI 0.25-0.96; I
conclusionEarly norepinephrine introduction in septic shock is associated with reduced mortality, decreased fluid volume administered at 6 h, faster time to achieve MAP target and more mechanical ventilation-free days. However, the trial sequential analysis indicates that further RCT are still needed to confirm these findings.
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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.