Norepinephrine (NE) is both an alpha1- and beta1-agonist, and is therefore able to increase vascular tone and contractility. Recent guidelines recommend NE as the first-line vasopressor in septic shock. However, because septic shock is a syndrome that results from a variable combination of decreased venous return, myocardial depression and decreased vascular tone, the place for NE in initial resuscitation is not straightforward. There is no doubt that prolonged hypotension contributes to the mortality of sepsis, but several issues, such as when to start NE, or the optimal mean arterial pressure (MAP) target in different contexts, are still controversial. This is particularly relevant since NE has a wide spectrum of effects on the cardiovascular system that could eventually increase or decrease systemic, regional or microcirculatory blood flow.

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