EFFECT OF EARLY VERSUS LATE ADMINISTRATION OF ADRENALINE IN PATIENTS WITH NORADRENALINE REFRACTORY SEPTIC SHOCK

Septic shock refractory to norepinephrine remains a critical therapeutic challenge, carrying high mortality despite guideline-directed resuscitation. Adrenaline is commonly employed as a rescue vasopressor in these cases, yet uncertainty persists regarding the optimal timing of its initiation. Early administration may enhance hemodynamic recovery, but evidence remains limited and inconsistent. Clarifying its timing could meaningfully influence shock reversal and patient outcomes.AIM OF THE WORKTo evaluate whether early initiation of adrenaline (within 6 hours of diagnosing norepinephrine-refractory septic shock) improves hemodynamic parameters and clinical outcomes compared with later initiation (6–24 hours).PATIENTS AND METHODS:In this single-center randomized study, 60 adults with norepinephrine-refractory septic shock were assigned to early (n = 30) or late (n=30) adrenaline initiation. Baseline characteristics were comparable between groups. Hemodynamics, urine output (UOP), vasopressor exposure, and outcomes including mechanical ventilation (MV) duration, shock resolution time, ICU/hospital length of stay, and mortality were assessed.RESULTS:Early adrenaline was associated with significantly faster shock resolution (5.73 ±1.10 vs. 8.00±0.96 days; P <0.001). Survivors in the early group achieved higher mean arterial pressure across days 1–7 (e.g., day 4: 81.4±3.2 vs. 74.4±4.5 mmHg; P <0.001) and greater UOP on days 2–5 (day 3: 896.7±159.8 vs. 578.6±120.4 mL/day; P < 0.001).