Vasopressor Management in Septic Shock Treatment

Septic shock arises when a dysregulated host response to infection produces profound vasodilatation, capillary leak and cellular hypoperfusion. Vasopressors have become indispensable to restore vascular tone and maintain mean arterial pressure (MAP) above critical thresholds to ensure organ perfusion. Current consensus designates norepinephrine as the first-line agent, owing to its balanced α-adrenergic vasoconstriction and modest β-adrenergic inotropy, and recommends early initiation in patients who remain hypotensive after initial fluid resuscitation. Second-line options, including vasopressin or its analogues, are employed to reduce catecholamine load and counter vasopressin deficiency commonly observed in septic shock. Optimal MAP targets are individualised, with a general aim of 65 mmHg, but may be adjusted upward in patients with chronic hypertension or evolving organ dysfunction. Recent advances emphasise standardised dosing metrics, integration of adjunctive agents and fluid-sparing strategies, as well as the timing of vasopressor onset. Together, these developments inform a global approach that balances efficacy, safety and resource availability, facilitating improved survival and reduced treatment-related adverse events.

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Vasopressor Management in Septic Shock Treatment publication trend

The graph below shows the total number of articles in vasopressor management in septic shock treatment across all publications each year (not limited to Nature Index journals).

Technical terms

Vasopressor: A pharmacological agent that constricts blood vessels to increase vascular tone and elevate blood pressure.

Septic shock: A subset of sepsis characterised by persistent hypotension and elevated lactate despite adequate fluid resuscitation, signifying circulatory and metabolic dysfunction.

Mean arterial pressure (MAP): The average arterial pressure during a single cardiac cycle, serving as a surrogate for organ perfusion pressure; commonly targeted at ≥65 mmHg.

Norepinephrine equivalent (NEE) score: A composite metric that converts various vasopressor dosages into a single standardised unit based on relative potency.

References

1. An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity. Critical Care (2023).
2. Early versus delayed administration of norepinephrine in patients with septic shock. Critical Care (2014).
3. Bench-to-bedside review: Vasopressin in the management of septic shock. Critical Care (2009).
4. Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature. Critical Care (2015).
5. Current use of vasopressors in septic shock. Annals of Intensive Care (2019).
6. Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis. Critical Care (2020).