الفهرس 
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Abstract
Septic shock is a common challenge in the intensive care unit (ICU). It is a sepsis with persisting hypotension which requires vasopressors to maintain mean arterial pressure (MAP) ≥ 65 mmHg and having a serum lactate level > 2 mmol/L (18 mg/dL) despite adequate volume resuscitation. Septic shock is characterized by hypovolemia (both relative and absolute) and decreased vascular tone. Both fluid resuscitation and vasopressors have an effect on hypovolemia and muscle tone at which fluid resuscitation aims to correct hypovolemia and vasopressors mainly norepinephrine (NE) as a first line agent aims to restore the vascular tone to ensure organ perfusion. Nevertheless, a large amount of fluids will increase the risk of fluid overload, which is a common complication during septic shock resuscitation. The present data shows that the time from the onset of septic shock to initial norepinephrine administration is an important determinant of survival The aim of this study was to investigate the impact of early norepinephrine administration on outcomes of patients with sepsis induced hypotension. The primary outcome measure was time to achieve target mean arterial pressure (≥ 65 mmHg). The secondary outcome measures were changes in quantity of norepinephrine, total volume of IV fluids administered, serum lactate level,30 days mortality rate and length of ICU stay. The patients were randomly allocated into two groups according to the management after first presentation using computer generated software : • group A (34 patients) received (30ml /kg of ideal body weight) ringer’s lactate solution after first presentation then norepinephrine was added when persistent mean arterial pressure (MAP)> 65 mmHg despite adequate fluid resuscitation. • group B (30 patients ): received (30ml /kg of ideal body weight) ringer’s lactate solution after first presentation combined with norepinephrine administration (0.05 mic/kg/min) The main findings in the current study can be summarized by: • There were no significant difference to demographic data (age, Predicted body weight, sex and the sources of sepsis), SOFA score, Length of ICU stay, hemoglobin level and platelet count. • There were significant increase in mean arterial blood pressure after 2 hours, urine output after 6 hours in group B compared to group A. • There was significant decrease in heart rate after 2 hours, time to reach target MAP ≥65 mmHg (after 1 hour), serum lactate level, total leukocyte count, creatinine level, urea level, volume of intravenous fluid, quantity of norepinephrine during 1st day and 30 days mortality in group B compared to group A.