Evaluation of the Efficacy of Epinephrine as a Vasopressor in the Management of Severe Sepsis: A Randomized Controlled Study

Abstract

Background: Norepinephrine is the first-line vasopressor in the management of severe sepsis. Epinephrine may be added or act as a substitute. Aims: To evaluate the efficacy of epinephrine in management of severe sepsis. Settings and Design: Intensive Care Unit, randomised controlled prospective study. Methods: 50 adult patients of both sexes suffering from severe sepsis and septic shock were studied. The patients were randomized into two groups each comprising of 25 patients. Group A patients were treated with norepinephrine and Group B patients with epinephrine. The patients were managed based on the early goal-directed therapy of sepsis management. After the first 6 hours of therapy the study drugs were compared on the basis of Pulse rate, CVP, MAP, ScvO2, SOFA score, time taken to achieve target MAP and the LOS in ICU. Statistical analysis used: Mean (SD), Unpaired and Paired 't' test Results: The pulse rate decreased significantly in Group A whereas it increased significantly in Group B (p < 0.01). The two groups showed statistically significant increment in CVP, MAP and ScvO2 after 6 hours of treatment. The decrease in SOFA score in both the groups was statistically significant (p < 0.001). The total intake and output of fluids (ml), length of ICU stay (LOS) and the time taken to achieve the target MAP were comparable between the two groups. Conclusion: Epinephrine is as effective as norepinephrine in the management of severe sepsis and septic shock. The beneficial aspect of epinephrine outweighs its adverse effects. It should be considered as a first-line drug especially in underdeveloped countries.