Norepinephrine

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 59-year-old woman exhibited lack of efficacy during treatment with norepinephrine for inotropic support.

The woman presented with 8-day history of mild dyspnoea, low-grade fever and dry cough. She was confirmed to be COVID-19 positive through a PCR test. Her skin examination was indicative of unilateral livedo reticularis; it gradually subsided within 24 hours of admission. On hospitalisation day 1, she received off-label therapy with azithromycin 500mg, ceftriaxone 2g, methylprednisolone 120mg and nadroparin-calcium [fraxiparin] 0.6mL twice daily. On hospital day 2, she received azithromycin 500mg, ceftriaxone 2g, methylprednisolone 120mg, nadroparin-calcium [fraxiparin] 0.6mL twice daily and lopinavir/ritonavir 200/50mg. On that day oxygen saturation was decreased, and she was transferred to ICU, and she was commenced on inotropic support with norepinephrine [noradrenaline; route and dosage not stated] and continuous positive airway pressure therapy. On day 3, She received off label-therapy with azithromycin 500mg, ceftriaxone 2g, methylprednisolone 120mg and nadroparin-calcium [fraxiparin] 0.6mL twice daily along with norepinephrine and continuous positive airway pressure therapy. From day 4 to day 12, she received off-label therapy with meropenem 1500mg along with azithromycin 500mg, ceftriaxone 2g, methylprednisolone 120mg, nadroparin-calcium [fraxiparin] 0.6mL twice daily, and norepinephrine and continuous positive airway pressure therapy. Additionally, she received invasive mechanical ventilation and intermittent positive-pressure ventilation. Eventually she died at day 12 of admission, despite the intensive treatment [exact immediate cause of death not stated].