Noradrenaline (Burns Shock — Vasopressor)

How it works

It is a potent alpha-1 adrenergic agonist with modest beta-1 activity, raising systemic vascular resistance and mean arterial pressure with limited effect on heart rate.

Prescribing in practice

• Administer through a central venous catheter via a controlled infusion device with continuous haemodynamic monitoring, because extravasation causes severe tissue necrosis and the burn patient may have limited access sites.
• It supports but does not replace adequate burns fluid resuscitation; vasopressor masking of under-resuscitation must be avoided and volume status reassessed continuously.
• Excessive vasoconstriction can compromise perfusion of grafts, flaps and burn-margin tissue, so titrate to the lowest effective pressure target.

Monitoring

Monitor mean arterial pressure, perfusion, urine output, lactate and the infusion site continuously, watching specifically for extravasation and distal ischaemia.

Counselling the patient

• Team: give centrally with continuous arterial pressure and perfusion monitoring.
• Team: ensure fluid resuscitation is optimised and reassess volume status alongside the vasopressor.
• Team: inspect the line site for extravasation and have an extravasation plan ready.

Evidence & guidelines

Noradrenaline is recommended as the first-line vasopressor in septic and distributive shock by the Surviving Sepsis Campaign, applied to burns critical care.