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1
The TRICYCLE trial evaluated early multimodal vasopressor therapy in patients with septic shock, emphasizing the need for dose ceiling rather than floor.
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2
In TRICYCLE, the norepinephrine equivalent (NEE) dose threshold was set at ≥0.15 µg/kg/min, but the actual median NEE at baseline exceeded this threshold.
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3
Higher baseline norepinephrine levels correlate with diminished likelihood of benefit from additional vasopressors, as shown in previous studies.
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4
Timing of vasopressor initiation is crucial, with mortality benefits decreasing significantly when treatment is delayed beyond 6 hours after septic shock onset.
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5
The authors suggest that future studies should establish a ceiling for qualifying doses and document timing to align the evaluated strategy with its intended purpose.
