Early Norepinephrine Administration and Rapid Dose Adjustment

NCT ID: NCT07343206

Last Updated: 2026-01-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

600 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-31

Study Completion Date

2028-03-31

Brief Summary

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The goal of this clinical trial is to determine whether early initiation of norepinephrine with rapid dose adjustment improves clinical outcomes in adult patients with septic shock. The study aims to evaluate the effect of early norepinephrine administration on mortality, hemodynamic stabilization, and resuscitation efficiency in adults aged 18 years and older diagnosed with septic shock.

The main questions it aims to answer are:

* Does early norepinephrine administration with rapid dose titration reduce 28-day mortality compared with standard treatment?
* Does early norepinephrine administration with rapid dose tiration lead to faster shock control and reduced fluid requirements without increasing treatment-related adverse events?

Researchers will compare early norepinephrine administration with rapid dose adjustment to placebo with standard sequential resuscitation and rescue norepinephrine as needed to see if early vasopressor initiation improves survival, shock resolution, and safety outcomes.

Participants will:

* Receive either norepinephrine or placebo infusion initiated within one hour of septic shock diagnosis, with dose adjustment every 15 minutes according to a standardized protocol
* Undergo close hemodynamic and safety monitoring, including frequent vital sign assessment and limb perfusion evaluation
* Receive standard sepsis care, including fluid resuscitation, antibiotics, and organ support as clinically indicated
* Be followed for clinical outcomes and adverse events for up to 28 days after enrollment

Detailed Description

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Conditions

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Sepsis Septic Shock

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Intervention

Norepinephrine 4 mg in 250 mL D5W, initiated at 0.05 mcg/kg/min. Titrate by 0.025 mcg/kg/min every 15 minutes if MAP \<65 mmHg, up to 0.15 mcg/kg/min maximum. Rescue norepinephrine available if needed (separate line). Limb ischemia monitoring every 15 minutes.

Duration: 24 hours.

Group Type EXPERIMENTAL

Early norepinephrine administration and rapid dose adjustment

Intervention Type DRUG

Norepinephrine 4 mg in 250 mL D5W, initiated at 0.05 mcg/kg/min. Titrate by 0.025 mcg/kg/min every 15 minutes if MAP \<65 mmHg, up to 0.15 mcg/kg/min maximum. Rescue norepinephrine available if needed (separate line). Limb ischemia monitoring every 15 minutes.

Duration: 24 hours.

Control

Placebo (D5W 250 mL) with an identical dosing schedule. Rescue norepinephrine available via a separate line. Same monitoring protocols.

Group Type SHAM_COMPARATOR

Control

Intervention Type DRUG

Placebo (D5W 250 mL) with an identical dosing schedule. Rescue norepinephrine available via a separate line. Same monitoring protocols.

Interventions

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Early norepinephrine administration and rapid dose adjustment

Norepinephrine 4 mg in 250 mL D5W, initiated at 0.05 mcg/kg/min. Titrate by 0.025 mcg/kg/min every 15 minutes if MAP \<65 mmHg, up to 0.15 mcg/kg/min maximum. Rescue norepinephrine available if needed (separate line). Limb ischemia monitoring every 15 minutes.

Duration: 24 hours.

Intervention Type DRUG

Control

Placebo (D5W 250 mL) with an identical dosing schedule. Rescue norepinephrine available via a separate line. Same monitoring protocols.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years
* Sepsis: SOFA ≥2 with suspected infection
* Mean arterial pressure \<65 mmHg
* Diagnosed within 3 hours

Exclusion Criteria

* Do-not-resuscitate orders
* Pregnancy
* Severe concurrent conditions (acute stroke, acute coronary syndrome, acute pulmonary edema, status asthmaticus, active gastrointestinal bleeding, status epilepticus, severe burn, severe trauma, and fatal drug overdose, End-stage malignancy
* Peripheral arterial disease
* Prior norepinephrine administration
* Recurrent shock in the same patient
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Maharaj Nakorn Si Thammarat

UNKNOWN

Sponsor Role collaborator

Kalasin Hospital

OTHER

Sponsor Role collaborator

Khon Kaen Hospital

OTHER_GOV

Sponsor Role collaborator

Udon Thani Regional Hospital

UNKNOWN

Sponsor Role collaborator

Hat Yai Hospital

UNKNOWN

Sponsor Role collaborator

Siriraj Hospital

OTHER

Sponsor Role lead

Responsible Party

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Wasin Pansiritanachot

Lecturer

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Chairat Permpikul, Professor

Role: PRINCIPAL_INVESTIGATOR

Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University

Locations

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Faculty of Medicine Siriraj Hospital, Mahidol University

Bangkok Noi, Bangkok, Thailand

Site Status

Kalasin Hospital

Kalasin, Changwat Kalasin, Thailand

Site Status

Khon Kaen hospital

Khon Kaen, Changwat Khon Kaen, Thailand

Site Status

Udon Thani Hospital

Udon Thani, Changwat Udon Thani, Thailand

Site Status

Hatyai Hospital

Hat Yai, Hat Yai, Thailand

Site Status

Maharaj Nakhon Si Thammarat Hospital

Nakhon Si Thammarat, ์Nakhon Si Thammarat, Thailand

Site Status

Countries

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Thailand

Central Contacts

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Titaporn Nasaarn, Medical Doctor

Role: CONTACT

+66 82 429 5514

Chairat Permpikul, Professor

Role: CONTACT

+66 81 408 1676

Facility Contacts

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Wasin Pansiritanachot, Medical Doctor

Role: primary

+66 89 680 8508

Suwimon Khansompop

Role: primary

+66942346394

Porntipa Tantibundit

Role: primary

+66815623688

Anutr Thitayanapong

Role: primary

+66802598884

Suratee Chobngam

Role: primary

+66074273100

Katsakorn Kheawkaew

Role: primary

+66886266464

Other Identifiers

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Si 930/2025

Identifier Type: -

Identifier Source: org_study_id

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