Renal effects of norepinephrine used to treat septic shock patients

Martin, Claude; Éon, B.; Saux, P.; Aknin, P.; Gouin, F.

doi:10.1097/00003246-199003000-00007

Cited by 169 publications

(64 citation statements)

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“…In addition to studies demonstrating increases in MAP, CO, and improved renal and intestinal blood flow (8,26,27,46), norepinephrine administration has been associated with improved outcome in septic shock patients. In a single observational study, patients receiving norepinephrine had significantly lower hospital mortality than patients receiving either high-dose dopamine or epinephrine (28).…”

mentioning

confidence: 99%

Differing effects of epinephrine, norepinephrine, and vasopressin on survival in a canine model of septic shock

Minneci

Deans²,

Banks³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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. Differing effects of epinephrine, norepinephrine, and vasopressin on survival in a canine model of septic shock. Am J Physiol Heart Circ Physiol 287: H2545-H2554, 2004. First published August 19, 2004 doi:10.1152/ ajpheart.00450.2004.-During sepsis, limited data on the survival effects of vasopressors are available to guide therapy. Therefore, we compared the effects of three vasopressors on survival in a canine septic shock model. Seventy-eight awake dogs infected with differing doses of intraperitoneal Escherichia coli to produce increasing mortality were randomized to receive epinephrine (0.2, 0.8, or 2.0, vasopressin (0.01 or 0.04 U/min), or placebo in addition to antibiotics and fluids. Serial hemodynamic and biochemical variables were measured. Increasing doses of bacteria caused progressively greater decreases in survival (P Ͻ 0.06), mean arterial pressure (MAP) (P Ͻ 0.05), cardiac index (CI) (P Ͻ 0.02), and ejection fraction (EF) (P ϭ 0.02). The effects of epinephrine on survival were significantly different from those of norepinephrine and vasopressin (P ϭ 0.03). Epinephrine had a harmful effect on survival that was significantly related to drug dose (P ϭ 0.02) but not bacterial dose. Norepinephrine and vasopressin had beneficial effects on survival that were similar at all drug and bacteria doses. Compared with concurrent infected controls, epinephrine caused greater decreases in CI, EF, and pH, and greater increases in systemic vascular resistance and serum creatinine than norepinephrine and vasopressin. These epinephrine-induced changes were significantly related to the dose of epinephrine administered. In this study, the effects of vasopressors were independent of severity of infection but dependent on the type and dose of vasopressor used. Epinephrine adversely affected organ function, systemic perfusion, and survival compared with norepinephrine and vasopressin. In the ranges studied, norepinephrine and vasopressin have more favorable risk-benefit profiles than epinephrine during sepsis.vasopressors and systemic perfusion; low cardiac output septic shock; vasopressors and acidosis; vasopressors and cardiac function DESPITE CONTINUED IMPROVEMENTS in medical therapy, mortality from septic shock has remained between 30% and 60% for the past three decades (1, 2). Septic shock is a clinically descriptive term that refers to a pathophysiological state of cardiovascular collapse associated with overwhelming infection. After adequate volume resuscitation, severe septic shock is often characterized by a hyperdynamic state with increased cardiac output (CO), hypotension, and decreased systemic vascular resistance (SVR). However, despite adequate volume resuscitation, 20 -25% of adult septic patients and 50 -60% of pediatric septic patients will present with low CO (3, 33, 34). The majority of septic patients will develop myocardial dysfunction and many will die as a consequence of multiple organ failure (17,35,44). During septic shock, tissue perfusion is compromised by hypotension, by the loss of vascul...

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confidence: 99%

Differing effects of epinephrine, norepinephrine, and vasopressin on survival in a canine model of septic shock

Minneci

Deans²,

Banks³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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“…Norepinephrine is the endogenous mediator of the sympathetic system having a strongadrenergic activity with less -adrenergic effects.It increases MAP by vasoconstriction, with small (10-15%) increase in cardiac output and stroke volume [53][54][55][56][57][58] .Filling pressure is either unchanged [59] or modestly increased (1-3 mm Hg) [54][55][56][57]. In open labels trials, norepinephrine at doses ranges 0.01 to 3.3µg/kg/min has demonstrated to increase MAP in patients who remained hypotensive after fluid resuscitation and dopamine [54-56 , 58, 60, 64-65].…”

Section: Norepinephrinementioning

confidence: 99%

Update in the Treatment of Severe Sepsis and Septic Shock

Boodoosingh¹,

Cruz²,

Egozcue³

et al. 2012

Severe Sepsis and Septic Shock - Understanding a Serious Killer

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“…32,44,45,47,48,50 In addition, there is evidence that norepinepherine may increase MAP in patients who are refractory to the administration of intravenous fluids and dopamine. 49,[51][52][53][54][55][56][57] However, dopamine has been in widespread use in the ED for decades and is conveniently supplied in a premixed solution.…”

Section: Rationalementioning

confidence: 99%

“…49,55,57 Other vasopressors, such as epinephrine and vasopressin, may also be used in septic patients, although current practice in Canadian EDs is limited. Vasopressin is a potent vasoconstrictor that acts as an agonist at the V1 receptor to constrict vascular smooth muscle.…”

Section: 45mentioning

confidence: 99%

Canadian Association of Emergency Physicians Sepsis Guidelines: the optimal management of severe sepsis in Canadian emergency departments

Green

Djogovic

Gray

et al. 2008

CJEM

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Introduction:Optimal management of severe sepsis in the ED has evolved rapidly. The purpose of these guidelines is to review key management principles for Canadian emergency physicians, utilizing an evidence-based grading system. Methods: Key areas in the management of septic patents were determined by members of the CAEP Critical Care Interest Group (C4). Members of C4 were assigned a question to be answered after literature review, based on the Oxford grading system. After completion, each section underwent a secondary review by another member of C4. A tertiary review was conducted by additional external experts, and modifications were determined by consensus. Grading was based on peer-reviewed publications only, and where evidence was insufficient to address an important topic, a "practice point" was provided based on group opinion. Results: The project was initiated in 2005 and completed in December 2007. Key areas which were reviewed include the definition of sepsis, the use of invasive procedures, fluid resuscitation, vasopressor/inotrope use, the importance of culture acquisition in the ED, antimicrobial therapy and source control. Other areas reviewed included the use of corticosteroids, activated protein C, transfusions and mechanical ventilation. Conclusion: Early sepsis management in the ED is paramount for optimal patient outcomes. The CAEP Critical Care Interest Group Sepsis Position Statement provides a framework to improve the ED care of this patient population. CAEP UPDATE • MISE À JOUR DE L'ACMU

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Renal effects of norepinephrine used to treat septic shock patients

Cited by 169 publications

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Differing effects of epinephrine, norepinephrine, and vasopressin on survival in a canine model of septic shock

Differing effects of epinephrine, norepinephrine, and vasopressin on survival in a canine model of septic shock

Update in the Treatment of Severe Sepsis and Septic Shock

Canadian Association of Emergency Physicians Sepsis Guidelines: the optimal management of severe sepsis in Canadian emergency departments

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