Comparative study of dopamine and norepinephrine in the management of septic shock (original) (raw)
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Indian Journal of Critical Care Medicine, 2007
Objective: Vasoconstrictors are one of the therapeutic modalities in the treatment of septic shock. In the present study, we have compared the effects of dopamine and norepinephrine in the treatment of septic shock with pre-defi ned end-points and continuous non-invasive cardiac output monitoring using impedance cardiography. Design: Randomized controlled trial. Settings: Sixteen-bedded mixed intensive care unit of a tertiary care teaching institution. Materials and Methods: The study included 50 consecutive patients presenting with septic shock and divided randomly into two groups with 25 patients in each group. Group I patients were treated with dopamine and those in Group II were treated with norepinephrine. They were optimized with fl uid resuscitation upto CVP>10 cm of H 2 O, packed red cells transfusion upto hematocrit >30, oxygenation and ventilation upto PaO 2 >60 mmHg before the inotropes were started. The goal of therapy was to achieve and maintain for six hours, all of the following: (1) SBP >90 mm Hg, (2) SVRI >1100 dynes.s/cm 5 m 2 , (3) Cardiac Index >4.0L/min/m 2 , (4) IDO 2 >550 ml/min/m 2 and (5) IVO 2 >150 ml/min/m 2. Measurements: The demographic data, baseline parameters and post-treatment parameters were statistically analyzed by using t-test. Results: The post-treatment parameters were statistically signifi cant showing the superiority of norepinephrine over dopamine in optimization of hemodynamics and patient survival. Signifi cant improvement in systolic blood pressure, heart rate, cardiac index, SVRI, IVO 2 and urine output were found in norepinephrine group than the dopamine group. Dopamine showed a response in 10 out of 25 patients up to a maximum dose of 25 mcg/kg/min while with norepinephrine, 19 patients responded up to a maximum dose of 2.5 mcg/kg/min The hemodynamic parameters were preserved in norepinephrine group with better preservation of organ perfusion and oxygen utilization with maintenance of splanchnic and renal blood fl ow as evidenced by signifi cant increase in O2 uptake and urine fl ow. Conclusion: Norepinephrine was more useful in reversing the hemodynamic and metabolic abnormalities of septic shock compared to dopamine at the doses tested.
Asian Journal of Pharmaceutical and Clinical Research, 2021
Septic shock is associated with refractory hypotension and organ dysfunction and remains an important cause of mortality in intensive care units (ICUs). Vasopressors are the first-line treatment. The present study aims to compare vasopressin and phenylephrine in the management of dopamine-resistant septic shock in the ICU setting. Methods: The study is a prospective, open-labeled, and randomized study comparing the effects of vasopressin (Group I) and phenylephrine (Group II) in the management of dopamine resistant septic shock in intensive care set up. The parameters recorded from 0 to 6 h after persistent hypotension despite maximum dose of dopamine were: Heart rate (HR) (beats/min), systemic blood pressure (mmHg), cardiac output (L/min), cardiac index (CI) (L/min/m 2), stroke volume (ml), systemic vascular resistance index (dynes/cm 5 /m 2), oxygen delivery index (IDO) (ml O 2 /min/m 2), urine output (ml), and serum lactate (mg/dl). Results: There was a significant difference in HR, systolic blood pressure, cardiac output, and CI in both groups from 1 h to 6 h. The IDO had a significant rise in Group II. The serum lactate level also decreased in Group II at 6 h. Conclusion: From our study, we concluded that as organ perfusion and oxygenation are more important for the treatment of septic shock and to keep the vital organs functioning rather than to increase the systemic vascular resistance and blood pressure, phenylephrine showed a better result than vasopressin in the treatment of septic shock.
The effects of norepinephrine infusion on oxygen consumption in a patient with septic shock
Intensive Care Medicine, 1990
A 65-year-old man developed postsurgical septic shock, unresponsive to plasma volume expansion and administration of dopamine and dobutamine. A continuous norepinephrine infusion was then started and the dose increased to 0.62 pg-kg-~. min-1 until the mean arterial pressure was 70 mmHg. Prior to and during the norepinephrine infusion, oxygen consumption was continuously measured with a mass spectrometer system. There was a parallel increase in mean arterial pressure and oxygen consumption (+35%). There was also an increase in cardiac index and oxygen delivery. Systemic vascular resistance was only transiently increased. In this case with septic shock, norepinephrine infusion improved hemodynamic variables with an associated increase in oxygen consumption.
Wiener klinische Wochenschrift, 2014
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Critical Care, 2008
Introduction Previous findings suggest that a delayed administration of phenylephrine replacing norepinephrine in septic shock patients causes a more pronounced hepatosplanchnic vasoconstriction as compared with norepinephrine. Nevertheless, a direct comparison between the two study drugs has not yet been performed. The aim of the present study was, therefore, to investigate the effects of a firstline therapy with either phenylephrine or norepinephrine on systemic and regional hemodynamics in patients with septic shock.
Critical Care Medicine, 2009
To investigate the effect of escalating doses of norepinephrine, aimed at achieving incremental increases in mean arterial pressure (MAP), on microvascular flow and tissue oxygenation in patients with septic shock. Design: Single-center interventional study. Setting: University hospital intensive care unit. Patients: Sixteen patients with established septic shock. Interventions: The norepinephrine dose was escalated to achieve incremental increases in the MAP from 60 to 70, 80, and 90 mm Hg. Measurements and Main Results: In addition to routine clinical measurements, cardiac output was determined using lithium dilution and arterial waveform analysis, cutaneous tissue PtO 2 was measured using a Clark electrode, cutaneous red blood cell flux was assessed using laser Doppler flowmetry, and sublingual microvascular flow was evaluated using sidestream darkfield imaging. The mean (SD) norepinephrine dose increased from 0.18 (0.18) g⅐kg ؊1 ⅐min ؊1 at 60 mm Hg to 0.41 (0.26) g⅐kg ؊1 ⅐min ؊1 at 90 mm Hg (p < 0.0001). During this period, global oxygen delivery increased from 487 (418-642) to 662 (498-829) mL⅐min ؊1 ⅐m ؊2 (p < 0.01), cutaneous PtO 2 increased from 44 (11) to 54 (13) mm Hg (p < 0.0001) and cutaneous microvascular red blood cell flux increased from 26.1 (16.2-41.9) to 33.3 (20.3-46.7) perfusion units (p < 0.05). No changes in sublingual microvascular flow index, vessel density, the proportion of perfused vessels, perfused vessel density, or heterogeneity index were identified by sidestream darkfield imaging. Conclusions: In patients with septic shock, targeting higher MAP by increasing the dose of norepinephrine resulted in an increase in global oxygen delivery, cutaneous microvascular flow, and tissue oxygenation. There were no changes in preexisting abnormalities of sublingual microvascular flow. Further research is required to clarify the optimal end points for vasopressor therapy in patients with septic shock.