Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: Which is best?*

Backer, Daniel De; Créteur, Jacques; Silva, Eliézer; Vincent, Jean‐Louis

doi:10.1097/01.ccm.0000063045.77339.b6

Cited by 304 publications

(178 citation statements)

References 38 publications

(50 reference statements)

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“…Rationale The physiologic effects of vasopressors and combined inotrope/vasopressor selection in septic shock are outlined in an extensive number of literature reviews [252][253][254][255][256][257][258][259][260][261]. Norepinephrine increases MAP due to its vasoconstrictive effects, with little change in heart rate and less increase in stroke volume compared with dopamine.…”

Section: G Vasoactive Medicationsmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: G Vasoactive Medicationsmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Among those patients, we selected those whose norepinephrine equivalent (the sum of all vasopressors administered, expressed as equivalent doses of norepinephrine) was Ն 1 m g/kg/min for Ն 10 min. We estimated norepinephrine dose equivalences (e-Table 1) based on prior studies, emphasizing studies in septic adults [8][9][10][11][12] rather than children, 13,14 animal models, 15 or healthy adults. 16 Briefl y, we considered 100 m g dopamine equivalent to 1 m g norepinephrine; 1 m g epinephrine equivalent to 1 m g norepinephrine; and 2.2 m g phenylephrine equivalent to 1 m g norepinephrine.…”

Section: Methodsmentioning

confidence: 99%

Survival After Shock Requiring High-Dose Vasopressor Therapy

Brown

Lanspa

Jones

et al. 2013

Chest

164

149

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Shock is an often lethal syndrome of diminished or insuffi cient perfusion that impairs organ function. Generally associated with decreased arterial blood pressure, shock results most commonly from sepsis, hemorrhage, or primary cardiac failure. 1 Vasopressor medications, largely vasoactive catecholamine hormones, have been used for many decades in the treatment of hypotensive shock. These medications have not been subjected to rigorous, placebo-controlled studies, and consensus from clinical experience suggests that there is not equipoise for such a study in most cases of shock. 2 When vascular tone is profoundly diminished (eg, vasoplegic syndrome or distributive shock), patients may require high-dose vasopressor therapy (HDV).Background: Some patients with hypotensive shock do not respond to usual doses of vasopressor therapy. Very little is known about outcomes after high-dose vasopressor therapy (HDV). We sought to characterize survival among patients with shock requiring HDV. We also evaluated the possible utility of stress-dose corticosteroid therapy in these patients.

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“…It increases mean arterial pressure by increasing cardiac output and stroke volume. 132 Deleterious effects associated with vasopressor agents include the development of splanchnic hypoperfusion, excess tachycardia and coronary ischemia. 133 Existing evidence has not definitively proven one vasopressor agent superior to another in the setting of severe sepsis or septic shock.…”

Section: Vasoactive Agentsmentioning

confidence: 99%

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity

Rivers

McIntyre

Morro

et al. 2005

Canadian Medical Association Journal

139

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Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: Which is best?*

Abstract: Dopamine and norepinephrine have similar hemodynamic effects, but epinephrine can impair splanchnic circulation in severe septic shock.

Cited by 304 publications

References 38 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Survival After Shock Requiring High-Dose Vasopressor Therapy

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity

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