Sepsis-induced hypotension at an intermediate care unit: observational results on the safety of peripherally administered norepinephrine

Shortage of available beds in intensive care units requires less resource-intensive treatment options for some patients with sepsis. Data on treating sepsis-induced hypotension with peripheral norepinephrine outside the intensive care unit remain scarce. We aimed to assess the feasibility of treating patients with sepsis-induced hypotension using norepinephrine administered via a peripheral intravenous catheter at an intermediate care unit. We conducted a retrospective observational study of patients with sepsis-induced hypotension who were treated with peripherally administered norepinephrine according to a specific protocol between January 2020 and July 2024 at the intermediate care unit at the Department of Medicine and Emergency Care Mölndal, Sahlgrenska University Hospital, in Gothenburg, Sweden. All data were extracted from the medical records. The primary outcomes were incidences of extravasation and tissue necrosis. 55 patients (median age 78 years, 42% female) treated with a median maximum norepinephrine dose of 0.09 µg/kg/min (interquartile range 0.05–0.13) for a median duration of 28 h (interquartile range 11.5–39). Only one patient (2%) experienced extravasation, and none developed tissue necrosis. 31 patients (84%) achieved the treatment target of mean arterial pressure ≥ 65 mmHg after 6 h. The mean rise in mean arterial pressure from baseline to infusion stop was 14.7 mmHg (95% confidence interval 10.2 to 19.2). In-hospital mortality was 31%. Treating sepsis-induced hypotension with norepinephrine administered through a peripheral intravenous catheter at an intermediate care unit according to a specific protocol seems to be a feasible treatment with a low incidence of complications. Our study highlights the role of the intermediate care unit in managing sepsis-induced hypotension.