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VOLUME 16 , ISSUE 2 ( April, 2012 ) > List of Articles


Norepinephrine supplemented with dobutamine or epinephrine for the cardiovascular support of patients with septic shock

Khaled M. Mahmoud, Amany S. Ammar

Keywords : Cardiovascular support, dobutamine, epinephrine, norepinephrine, septic shock

Citation Information : Mahmoud KM, Ammar AS. Norepinephrine supplemented with dobutamine or epinephrine for the cardiovascular support of patients with septic shock. Indian J Crit Care Med 2012; 16 (2):75-80.

DOI: 10.4103/0972-5229.99110

License: CC BY-ND 3.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2012; The Author(s).


Background and Aims: Sepsis management remains a great challenge for intensive care medicine. The aim of this study was to evaluate the effect of adding dobutamine versus epinephrine to norepinephrine in treating septic shock patients refractory to fluid therapy. Materials and Methods: Sixty adult patients with the diagnosis of septic shock were included in this study. Norepinephrine infusion was started at a dose of 0.05 μg/kg/min, and increased gradually up to 0.1 μg/kg/min. Upon reaching this dose, patients with mean arterial pressure <70 mmHg were further divided randomly into two equal groups. In group I: the patients continued on norepinephrine and dobutamine was added at a starting dose of 3 μg/kg/min and increased in increments of 2 μg/kg/min up to 20 μg/kg/min. In group II: the patients continued on norepinephrine and epinephrine was added in a starting dose of 0.05 μg/kg/ min and increased in increments of 0.03 μg/kg/min up to 0.3 μg/kg/min. Results: Group II patients developed significantly better cardiovascular parameters, lower arterial pH and higher serum lactate and urine output; however, the 28-day mortality and major adverse effects were comparable in both groups. Conclusions: The addition of epinephrine to norepinephrine has positive effects on the cardiovascular parameters but negative results on the serum lactate concentration and systemic pH compared with the addition of dobutamine to norepinephrine.

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  1. A blue print for a sepsis protocol. Acad Emerg Med 2005;12:352-9.
  2. Incidence, organ dysfunction and mortality in severe sepsis: A Spanish multicentre study. Crit Care 2008;12:R158.
  3. Myocardial dysfunction in meningococcal septic shock. Curr Opin Crit Care 2005;11:418-23.
  4. Microcirculation in sepsis and septic shock-therapeutic options? Anaesthesiol Intensivmed Notfallmed Schmerzther 2008;43:48-53.
  5. A modified goal-directed protocol improves clinical outcomes in intensive care unit patients with septic shock: A randomized controlled trial. Shock 2006;26:551-7.
  6. The impact of organ failures and their relationship with outcome in intensive care: Analysis of a prospective multicentre database of adult admissions. Anaesthesia 2006;61:731-8.
  7. Early preload adaptation in septic shock? A transesophageal echocardiographic study. Anesthesiology 2001;94:400-6.
  8. Vasopressor and inotropic support in septic shock: An evidence-based review. Crit Care Med 2004;32:S455-65.
  9. An appraisal of selection and use of catecholamines in septic shock - old becomes new again. Crit Care Resusc 2006;8:353-60.
  10. The effect of a quantitative resuscitation strategy on mortality in patients with sepsis: A meta-analysis. Crit Care Med 2008;36:2734-9.
  11. Current concepts in severe sepsis and septic shock. J Pharmacol Pract 2005;18:351-62.
  12. Implementation of a norepinephrine-based protocol for management of septic shock: A pilot feasibility study. J Trauma 2006;60:77-81.
  13. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: A randomized trial. Lancet 2007;370:676-84.
  14. Differing effects of epinephrine, norepinephrine and vasopressin on survivals in a canine model of septic shock. Am J Physiol Heart Cric Physiol 2004;287:H 2545-54.
  15. Effects of epinephrine, norepinephrine and phenylephrine on microcirculation blood flow in the gastrointestinal tract in sepsis. Crit Care Med 2006;34:1456-63.
  16. Dobutamine compensates deleterious hemodynamic and metabolic effects of vasopressin in the splanchnic region in endotoxin shock. Acta Anaesthesiol Scand 2004;48:935-43.
  17. Cardiovascular support in septic shock. Air Med J 2007;26:240-7.
  18. Septic shock: Does adrenaline have a role as a first-line inotropic agent? Anaesth Intensive Care 1992;20:470-4.
  19. Epinephrine as an inotropic agent in septic shock: A dose-profile analysis. Crit Care Med 1993;21:70-7.
  20. Effects of epinephrine on right ventricular function in patients with severe septic shock and right ventricular failure: A preliminary descriptive study. Intensive Care Med 1997;23:664-70.
  21. Dopexamine and norepinephrine versus epinephrine on gastric perfusion in patients with septic shock: A randomized study. Crit Care 2006;10:R32.
  22. The effect of epinephrine, norepinephrine or the combination of norepinephrine and dobutamine on gastric mucosa in septic shock. Crit Care Med 1999;27:893-900.
  23. Lactate and shock: The metabolic view. Curr Opin Crit Care 2006;12:315-21.
  24. Relation between muscle Na + K + ATPase and raised lactate concentration in septic shock: A prospective study. Lancet 2005;365:871-5.
  25. Increasing mean arterial pressure in patients with septic shock: Effects on oxygen variables and renal function. Crit Care Med 2005;33:780-6.
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