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Early Norepinephrine Administration in Septic Shock Early Norepinephrine Administration in Septic Shock | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Our Team Sections Education Alumni Research ECRC Journal Club Events Jermyn Lectures Open Search Vignette You are working an overnight shift in TCC one evening when you get the following page: “Triage patient to 3L.” No other information is provided, but when the patient finally (...) , but while ordering this, you wonder if you should also initiate vasopressors. while your attending instructs you to wait and see how she responds to the fluid bolus, you remember reading an article in one of the “throw away” journals you receive suggesting that there was a benefit to early norepinephrine administration in sepsis, initiated concomitant with fluid resuscitation. After the patient’s fluid bolus, she remains hypotensive (MAP 59) and a norepinephrine is initiated. As the patient
Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial Rationale: Recent retrospective evidence suggests the efficacy of early norepinephrine administration during resuscitation; however, prospective data to support this assertion are scarce. Objectives: To conduct a phase II trial evaluating the hypothesis that early low-dose norepinephrine in adults with sepsis with hypotension increases shock control by 6 hours compared with standard care. Methods: This single (...) -center, randomized, double-blind, placebo-controlled clinical trial was conducted at Siriraj Hospital, Bangkok, Thailand. The study enrolled 310 adults diagnosed with sepsis with hypotension. The patients were randomly divided into two groups: early norepinephrine (n = 155) and standard treatment (n = 155). The primary outcome was shock control rate (defined as achievement of mean arterial blood pressure ≥65 mm Hg, with urine flow ≥0.5 ml/kg/h for 2 consecutive hours, or decreased serum lactate ≥10
Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery: A Randomized Dose-finding Trial Norepinephrine has been recently introduced for prophylaxis against postspinal hypotension during cesarean delivery; however, no data are available regarding its optimum dose. The objective of this study is to compare three infusion rates of norepinephrine for prophylaxis against postspinal hypotension during cesarean delivery.The authors conducted a double-blinded (...) , randomized, controlled study including full-term pregnant women scheduled for cesarean delivery. Norepinephrine infusion was commenced after subarachnoid block. Patients were randomized into three groups, which received norepinephrine with starting infusion rates of 0.025 μg · kg(-1) · min(-1), 0.050 μg · kg(-1) · min(-1), and 0.075 μg · kg(-1) · min(-1). Infusion was stopped when intraoperative hypertension occurred. The primary outcome was the frequency of postspinal hypotension (defined as decreased
Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction Vasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardial infarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking.The goal of this paper was to compare in a prospective, double-blind, multicenter (...) , randomized study, the efficacy and safety of epinephrine and norepinephrine in patients with CS after acute myocardial infarction.The primary efficacy outcome was cardiac index evolution, and the primary safety outcome was the occurrence of refractory CS. Refractory CS was defined as CS with sustained hypotension, end-organ hypoperfusion and hyperlactatemia, and high inotrope and vasopressor doses.Fifty-seven patients were randomized into 2 study arms, epinephrine and norepinephrine. For the primary
Vasopressin Versus Norepinephrine for the Management of Septic Shock in Cancer Patients: The VANCS II Randomized Clinical Trial Previous trials suggest that vasopressin may improve outcomes in patients with vasodilatory shock. The aim of this study was to evaluate whether vasopressin could be superior to norepinephrine to improve outcomes in cancer patients with septic shock.Single-center, randomized, double-blind clinical trial, and meta-analysis of randomized trials.ICU of a tertiary care (...) hospital.Two-hundred fifty patients 18 years old or older with cancer and septic shock.Patients were assigned to either vasopressin or norepinephrine as first-line vasopressor therapy. An updated meta-analysis was also conducted including randomized trials published until October 2018.The primary outcome was all-cause mortality at 28 days after randomization. Prespecified secondary outcomes included 90-days all-cause mortality rate; number of days alive and free of advanced organ support at day 28
Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock. Drug shortages in the United States are common, but their effect on patient care and outcomes has rarely been reported.To assess changes to patient care and outcomes associated with a 2011 national shortage of norepinephrine, the first-line vasopressor for septic shock.Retrospective cohort study of 26 US hospitals in the Premier Healthcare Database with a baseline rate of norepinephrine use (...) of at least 60% for patients with septic shock. The cohort included adults with septic shock admitted to study hospitals between July 1, 2008, and June 30, 2013 (n = 27 835).Hospital-level norepinephrine shortage was defined as any quarterly (3-month) interval in 2011 during which the hospital rate of norepinephrine use decreased by more than 20% from baseline.Use of alternative vasopressors was assessed and a multilevel mixed-effects logistic regression model was used to evaluate the association between
Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. Norepinephrine is currently recommended as the first-line vasopressor in septic shock; however, early vasopressin use has been proposed as an alternative.To compare the effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock.A factorial (2×2), double-blind, randomized clinical trial conducted in 18 general adult intensive care (...) units in the United Kingdom between February 2013 and May 2015, enrolling adult patients who had septic shock requiring vasopressors despite fluid resuscitation within a maximum of 6 hours after the onset of shock.Patients were randomly allocated to vasopressin (titrated up to 0.06 U/min) and hydrocortisone (n = 101), vasopressin and placebo (n = 104), norepinephrine and hydrocortisone (n = 101), or norepinephrine and placebo (n = 103).The primary outcome was kidney failure-free days during the 28
The effect of norepinephrine versus epinephrine in irrigation fluid on the incidence of hypotensive/bradycardic events during arthroscopic rotator cuff repair with interscalene block in the sitting position To compare the occurrence rate of hypotensive and bradycardic events (HBEs) during arthroscopic rotator cuff repair performed with interscalene brachial plexus block anesthesia in the sitting position in 2 groups of patients who underwent the procedure with norepinephrine or epinephrine (...) added to the irrigation fluid. The secondary objective was to evaluate the efficacy of norepinephrine in comparison with epinephrine in controlling intraoperative bleeding and maintaining adequate visualization of the arthroscopic field of view during the procedure. We hypothesized that norepinephrine added to the irrigation fluid during shoulder arthroscopy in the sitting position would reduce the occurrence of HBEs, allowing optimal intraoperative bleeding control.One hundred twenty patients
Is the Addition of Vasopressin to Norepinephrine Beneficial for the Treatment of Septic Shock? SystematicReviewSnapshot TAKE-HOME MESSAGE The addition of low-dose vasopressin to norepinephrine may not signi?cantly reduce mortality in adult patients with septic shock. METHODS DATA SOURCES MEDLINE (1966 to 2011) and CENTRAL (1800 to 2011) data- bases were searched and ab- stracts from recent major confer- ences were reviewed by 3 of the authors. STUDY SELECTION Randomized controlled trials evalu (...) was calculated with a ?xed-effect model and was represented with forest plots; heterogeneity was evaluated with a 2 test. Subgroup analysis of just patients with sepsis was per- formed. Individual study investiga- tors were contacted as necessary for clari?cation after data were extracted. Study quality was Is the Addition of Vasopressin to Norepinephrine Bene?cial for the Treatment of Septic Shock? EBEM Commentators John P. Sandifer, MD Alan E. Jones, MD Department of Emergency Medicine University
Dopamine versus Norepinephrine For the Treatment of Septic Shock SystematicReviewSnapshot TAKE-HOME MESSAGE Dopamine administration is associated with a higher incidence of arrhythmias and increased risk of death compared with norepinephrine in the treatment of septic shock. METHODS DATA SOURCES The search included MEDLINE, EMBASE, Scopus databases, and the Cochrane registry of clinical trials (through June 30, 2011). Google Scholar, clinical trials.org, controlled-trials.com, and ab- stracts (...) of major congresses (2005 to 2010) were also searched. STUDY SELECTION Studies providing outcome data on the use of dopamine com- pared with norepinephrine in the treatment of septic shock were included; observational and ran- domized controlled trials were evaluated separately. Animal trials, pediatric trials, and crossover de- sign trials were excluded. DATA EXTRACTION AND SYNTHESIS Two authors independently ex- tracted data from all studies, and the Cochrane risk of bias tool was used. Twenty-eight
Effect of intravenous lidocaine associated with amitriptyline on pain relief and plasma serotonin, norepinephrine, and dopamine concentrations in fibromyalgia. The objective of this study was to evaluate the effect of intravenous lidocaine combined with amitriptyline on pain relief and plasma serotonin, norepinephrine, and dopamine levels.A prospective, randomized, double-blind comparative study was conducted in 30 patients. All patients received 25 mg amitriptyline; monotherapy group (n=15 (...) ) received 125 mL saline, and combined therapy group (n=15) received 240 mg lidocaine in 125 mL saline once a week for 4 weeks. Serotonin, norepinephrine, and dopamine were measured in plasma at time zero (T0) and after 4 weeks (T4). Pain intensity was rated on a numerical scale at the beginning of the study and weekly for 4 weeks.All patients were females and the mean age was 44.7±10.5 years for monotherapy group and 40.9±11.6 years for combined therapy group. No difference in pain intensity at baseline
Comparison of dopamine and norepinephrine in the treatment of shock. Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained (...) with a dose of 20 microg per kilogram of body weight per minute for dopamine or a dose of 0.19 microg per kilogram per minute for norepinephrine, open-label norepinephrine, epinephrine, or vasopressin could be added. The primary outcome was the rate of death at 28 days after randomization; secondary end points included the number of days without need for organ support and the occurrence of adverse events.The trial included 1679 patients, of whom 858 were assigned to dopamine and 821 to norepinephrine
Selective serotonin and norepinephrine reuptake inhibitors (SNRI) for patients with depression; version 1.0 Executive Summary IQWiG Reports – Commission No. A05-20A Selective serotonin and norepinephrine reuptake inhibitors (SNRI) for patients with depression 1 1 Translation of the executive summary of the final report “Selektive Serotonin- und Noradrenalin- Wiederaufnahmehemmer (SNRI) bei Patienten mit Depressionen” (Version 1.0; Status: 17.06.2009). Please note: This translation is provided (...) as a service by IQWiG to English-language readers. However, solely the German original text is absolutely authoritative and legally binding. Executive summary of final report A05-20A SNRI for patients with depression Version 1.0 17.06.2009 Publishing details Publisher: Institute for Quality and Efficiency in Health Care Topic: Selective serotonin and norepinephrine reuptake inhibitors (SNRI) for patients with depression Contracting agency: Federal Joint Committee Commission awarded on: 22.02.2005 Internal