Effects of norepinephrine on static and dynamic preload indicators in experimental hemorrhagic shock*

Nouira, Semir; Elatrous, Souheil; Dimassi, Sarra; Ouanes-Besbes, Lamia; Boukef, Riadh; Benzarti, M.; Abroug, Fékri

doi:10.1097/01.ccm.0000182801.48137.13

Cited by 111 publications

(69 citation statements)

References 26 publications

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“…37 However, an experimental study performed on dogs demonstrated that PPV decreased during an NE perfusion, despite increased vascular tone. 25 As mentioned earlier, the present result is related to the fact that vasopressors also diminish PPV by increasing venous return. Without doubt, our study confirms the hypothesis that vasopressors, such as NE and EPI, increase venous return and ventricular preload (Fig.…”

Section: Discussionsupporting

confidence: 48%

“…By harvesting blood from the splanchnic territory, for example, catecholamines could increase the venous return and stroke volume, thereby diminishing preload dependency and dynamic indices. 25,26 In this regard, both PPV and SVV, which are valid indices of fluid depletion and fluid responsiveness, 24 diminished significantly under NE and EPI perfusions. The present hemodynamic changes were related to changes in venous return, as we demonstrated that IVCF, which diminishes during hypovolemia, increased following catecholamine infusions.…”

Section: Discussionmentioning

confidence: 99%

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Impact of epinephrine and norepinephrine on two dynamic indices in a porcine hemorrhagic shock model

Giraud

Siegenthaler

Arroyo

et al. 2014

Journal of Trauma and Acute Care Surgery

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BACKGROUND: Pulse pressure variations (PPVs) and stroke volume variations (SVVs) are dynamic indices for predicting fluid responsiveness in intensive care unit patients. These hemodynamic markers underscore Frank-Starling law by which volume expansion increases cardiac output (CO). The aim of the present study was to evaluate the impact of the administration of catecholamines on PPV, SVV, and inferior vena cava flow (IVCF). METHODS:In this prospective, physiologic, animal study, hemodynamic parameters were measured in deeply sedated and mechanically ventilated pigs. Systemic hemodynamic and pressure-volume loops obtained by inferior vena cava occlusion were recorded. Measurements were collected during two conditions, that is, normovolemia and hypovolemia, generated by blood removal to obtain a mean arterial pressure value lower than 60 mm Hg. At each condition, CO, IVCF, SVV, and PPV were assessed by catheters and flow meters. Data were compared between the conditions normovolemia and hypovolemia before and after intravenous administrations of norepinephrine and epinephrine using a nonparametric Wilcoxon test. RESULTS:Eight pigs were anesthetized, mechanically ventilated, and equipped. Both norepinephrine and epinephrine significantly increased IVCF and decreased PPV and SVV, regardless of volemic conditions ( p G 0.05). However, epinephrine was also able to significantly increase CO regardless of volemic conditions. CONCLUSION: The present study demonstrates that intravenous administrations of norepinephrine and epinephrine increase IVCF, whatever the volemic conditions are. The concomitant decreases in PPV and SVV corroborate the fact that catecholamine administration recruits unstressed blood volume. In this regard, understanding a decrease in PPV and SVV values, after catecholamine administration, as an obvious indication of a restored volemia could be an outright misinterpretation. (J Trauma Acute Care Surg. 2014;77: 564Y569.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Impact of epinephrine and norepinephrine on two dynamic indices in a porcine hemorrhagic shock model

Giraud

Siegenthaler

Arroyo

et al. 2014

Journal of Trauma and Acute Care Surgery

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“…Similar results have been reported by previous studies showing that pulse pressure variation (PPV), a good marker of preload dependency, decreased with noradrenaline administration (62,63). Recently, some studies have reported the effect of noradrenaline on Pmsf in humans, using the method of inspiratory hold manoeuvres described by Maas et al (104) in mechanical ventilated patients.…”

Section: Vasopressorssupporting

confidence: 74%

“…In these studies, the venoconstriction generated by noradrenaline recruits part of the unstressed volume into the stressed volume, due to small changes in venous compliance (57)(58)(59). This mechanism allows a transfer of blood volume from the splanchnic beds to the heart increasing right ventricular filling (60)(61)(62). (65) studied the effects of noradrenaline infusions on cardiac output in sixteen postoperative cardiac surgical patients using an increase of 20 mmHg in MAP as a target.…”

Section: For Blood Pressurementioning

confidence: 99%

Perioperative Haemodynamic Optimisation

Aya¹,

Cecconi²,

Rhodes³

2014

Turk J Anesth Reanim

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56During the latest years, a number of studies have confirmed the benefits of perioperative haemodynamic optimisation on surgical mortality and postoperative complication rate. This process requires the use of advanced haemodynamic monitoring with the purpose of guiding therapies to reach predefined goals. This review aim to present recent evidence on perioperative goal directed therapy (GDT), with an emphasis in some aspects that may merit further investigation. In order to maximise the benefits on outcomes, GDT must be implemented as early as possible; intravascular volume optimisation should be in accordance with the response of the preload-reserve, goals should be individualised and adequacy of the intervention must be also assessed; non-invasive or minimally invasive monitoring should be used and, finally, side effects of every therapy should be taken into account in order to avoid undesired complications. New drugs and technologies, particularly those exploring the venous side of the circulation, may improve in the future the effectiveness and facilitate the implementation of this group of therapeutic interventions.

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“…NE is a potent vasoactive agent with alphaand beta-adrenergic properties that is widely used for the treatment of hypotension secondary to vasodilatation in hemorrhagic or septic shock (16), and that has no effect on cerebrovascular hemodynamics during intact circulation (17). The rationale for NE therapy during hemorrhagic shock is rooted in the fact that NE has been claimed to shift venous blood from unstressed to stressed vascular bed (18). Therefore, NE administration may support activation of the endogenous sympatho-adrenergic system in shifting blood volume to the central compartment, and thereby, preserving blood flow to the heart and brain.…”

mentioning

confidence: 99%

Impact of Norepinephrine and Fluid on Cerebral Oxygenation in Experimental Hemorrhagic Shock

et al. 2007

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Few data exist regarding resuscitation of hypovolemic shock in infants, and alternative strategies such as vasopressor therapy merit further evaluation. However, the effects of norepinephrine on cerebral perfusion and oxygenation during hemorrhagic shock in the pediatric population are still unclear. Eight anesthetized piglets were subjected to hypotension by blood withdrawal of 25 mL/kg. Norepinephrine was titrated to achieve baseline mean arterial blood pressure (MAP), and cerebral oxygenation was determined by brain tissue PO 2 (P ti O 2 ) and near-infrared spectroscopy-derived tissue oxygen index (TOI). Then, norepinephrine was stopped, MAP was allowed to decrease again below 30 mm Hg, and shed blood was retransfused. During hemorrhage, TOI dropped from 69 Ϯ 3 to 59 Ϯ 3%, and P ti O 2 from 29 Ϯ 6 to 13 Ϯ 1 mm Hg (mean Ϯ SEM; p Ͻ 0.001). Following norepinephrine, cerebral perfusion pressure (CPP) could be restored immediately, whereas TOI and P ti O 2 did not increase significantly. In contrast, following retransfusion, TOI and P ti O 2 increased to 68 Ϯ 3% and 27 Ϯ 7 mm Hg reaching baseline values, respectively. In conclusion, while norepinephrine increased CPP immediately, cerebral oxygenation as reflected by TOI and P ti O 2 could not be improved by norepinephrine, but only by retransfusion. H ypovolemia is the most common cause of circulatory failure in children (1). When inadequate tissue perfusion is not recognized and treated rapidly, critical tissue hypoxia may develop, leading to multiorgan failure and global cerebral ischemia followed by impaired brain function (2). With respect to hypovolemic and hemorrhagic shock, few clinical and experimental data exist in infants (3). In adults, there is growing evidence that conventionally aggressive fluid resuscitation does not increase the chance of survival in hemorrhagic shock (4). Accordingly, alternative strategies such as vasopressor therapy merit further evaluation. Administration of the widely used norepinephrine (NE) has been advocated to control hypotension, even in the acute phase of hemorrhage (5). Preliminary experimental data have suggested that early administration of NE may improve cerebral perfusion and oxygenation, at least in a model of brain-injury (6). However, the effects of NE on systemic hemodynamics and cerebral perfusion and oxygenation in a pediatric model of hemorrhagic shock are still unclear.NIRS is a relatively new technique with the capacity to detect changes in cerebral hemodynamics and oxygenation continuously and noninvasively at the bedside (7). In addition, impaired cerebral oxygenation has been found to correlate closely to experimental hypotension-induced alterations in cerebral blood flow (CBF) (8). Thus, we undertook this study to determine in a pediatric model of hemorrhagic shock 1) whether changes in cerebral perfusion and oxygenation accompanying hemorrhage could be detected by NIRS, and 2) whether the use of NE would improve cerebral perfusion and oxygenation. MATERIALS AND METHODSThis is an experimental ...

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Effects of norepinephrine on static and dynamic preload indicators in experimental hemorrhagic shock*

Cited by 111 publications

References 26 publications

Impact of epinephrine and norepinephrine on two dynamic indices in a porcine hemorrhagic shock model

Impact of epinephrine and norepinephrine on two dynamic indices in a porcine hemorrhagic shock model

Perioperative Haemodynamic Optimisation

Impact of Norepinephrine and Fluid on Cerebral Oxygenation in Experimental Hemorrhagic Shock

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