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VOLUME 14 , ISSUE 1 ( January, 2010 ) > List of Articles

RESEARCH ARTICLE

Comparison of phenylephrine and norepinephrine in the management of dopamine-resistant septic shock

D. K. Singh

Keywords : Dopamine, norepinephrine, phenylephrine

Citation Information : Singh DK. Comparison of phenylephrine and norepinephrine in the management of dopamine-resistant septic shock. Indian J Crit Care Med 2010; 14 (1):29-34.

DOI: 10.4103/0972-5229.63033

License: CC BY-ND 3.0

Published Online: 01-03-2006

Copyright Statement:  Copyright © 2010; The Author(s).


Abstract

Introduction: This study aims to compare two vasoconstrictors: - norepinephrine and phenylephrine - in the management of dopamine- resistant septic shock. Materials and Methods: We performed a randomized, prospective, controlled trial in 54 septic shock patients, with persistent hypotension despite adequate volume resuscitation and continued dopamine infusion ~25μg/kg/h. Patients were randomly allocated into two groups to receive either norepinephrine or phenylephrine infusion (n = 27 each) titrated to achieve a target of SBP > 90mm Hg, MAP > 75 mm Hg, SVRI > 1100 dynes.s/cm5m2, CI > 2.8 L/min/m2, DO2I > 550 ml/min/m2, and VO2I > 150 ml/min/m2 for continuous 6 h. All the parameters were recorded every 30 min and increment in dose of studied drug was done in the specified dose range if targets were not achieved. Data from pulmonary arterial and hepatic vein catheterization, thermodilution catheter, blood gas analysis, blood lactate levels, invasive blood pressure, and oxygen transport variables were compared with baseline values after achieving the targets of therapy. Differences within and between groups were analyzed using a one-way analysis of variance test and Fischer′s exact test. Results: No difference was observed in any of the investigated parameters except for statistically significant reduction of heart rate (HR) (P< 0.001) and increase in stroke volume index (SVI) (P< 0.001) in phenylephrine group as compared to nonsignificant change in norepinephrine group. Conclusions: Phenylephrine infusion is comparable to norepinephrine in reversing hemodynamic and metabolic abnormalities of sepsis patients, with an additional benefit of decrease in HR and improvement in SVI.


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  1. Siegel JH, Greenspan M, Del Guercio LR. Abnormal vascular tone defective oxygen transport and myocardial failure in human septic shock. Ann Surg 1967;165:504-17.
  2. Shoemaker WC, Appel PL, Kram HB, Waxman K, Leet S. Prospective trial of supra normal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988;94:1176-86.
  3. Morelli A, Ertmer C, Rehberg S, Lange M, Orecchioni, Laderchi A, et al. Phenylephrine versus norepinephrine for initial hemodynamic support of patients with septic shock: a randomized, controlled trial. Crit Care 2008;12:R143.
  4. Ognibene FP. Hemodynamic support during sepsis. Clin Chest Med 1996;17:279.
  5. Levy B, Bollaert PE, Charpentier C. Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: a prospective, randomized study. Intensive Care Med 1997;23:282.
  6. Mathur SK, Dhunna R, Chakraborthy A. Comparison of norepinephrine and dopamine in the management of septic shock using impedence cardiography. Indian J Crit Care Med 2009;11:186-91.
  7. Krieger BE, Craven DE, McCabe WR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 1980;68:344.
  8. Rudis MI, Basha MA, Zarowitz BJ. Is it time to reposition vasopressors and inotropes in sepsis. Crit Care Med 1996;24:525.
  9. Levy B, Bollaert PE, Charpentier C. Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: a prospective, randomized study. Intensive Care Med 1997;23:282.
  10. Bonfiglio MF, Dasta JF, Gregory JS, Townsend MC, Reilley TE, Flancbaum L. High-dose phenylephrine infusion in the hemodynamic support of septic shock. DICP 1990;24:936-9.
  11. Gregory JS, Bonfiglio MF, Dasta JF, Reilley TE, Townsend MC, Flancbaum L. Experience with phenylephrine as a component of the pharmacologic support of septic shock. Crit Care Med 1991;19:1395-400.
  12. Hofmann BB, Lefkowitz RJ. Catecholamines and sympathomimetic drugs. In: Alfred Gilman, Louis S Goodman, Brian B Hoffman, Robert J Lefkowitz, editor. Goodman and Gilman′s the pharmacological basis of therapeutics. New York: Pergamon; 1991. p. 187-220.
  13. Sander O, Welters ID, Foex P, Sear JW. Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications. Crit Care Med 2005;33:81-8.
  14. Marik PE. Gastric intramucosal pH a better predictor of multiorgan dysfunction syndrome and death than oxygen-derived variables in patients with sepsis. Chest 1993;104:225.
  15. Maynard N, Bihari D, Beale R. Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA 1993;270:1203.
  16. Wilson W, Lipman J, Scribante J. Septic shock: does adrenaline have a role as a first line inotropic agent. Anaesth Intensive Care 1992;20:470.
  17. Martin C, Papazian L, Perrin G, Saux P, Gouin F. Norepinephrine or dopamine for the treatment of hyperdynamic septic shock. Chest 1993;103: 1826-31.
  18. Nygren A, Thoren A, Ricksten SE. Effects of norepinephrine alone and norepinephrine plus dopamine on human intestinal mucosal perfusion. Intensive Care Med 2003;29: 1322-8.
  19. Beale RJ, Hollenberg SM, Vincent JL, Parrillo JE. Vasopressor and inotropic support in septic shock: an evidence-based review. Crit Care Med 2004;32: 455-65.
  20. Schwarz B, Hofstφtter H, Salak N, Pajk N, Knotzer H, Mayr A, et al. Effects of norepinephrine and phenylephrine on intestinal oxygen supply and mucosal tissue oxygen tension. Intensive Care Med 2001;27:593-601.
  21. Krejci V, Hiltebrand LB, Sigurdsson GH. Effects of epinephrine, norepinephrine, and phenylephrine on microcirculatory blood flow in the gastrointestinal tract in sepsis. Crit Care Med 2006;34:1456-63.
  22. Morelli A, Lange M, Ertmer C, Dόnser M, Rehberg S, Bachetoni A, et al. Short-term effects of phenylephrine on systemic and regional hemodynamics in patients with septic shock: a crossover pilot study. Shock 2008;29:446-51.
  23. Reinelt H, Radermacher P, Kiefer P, Fischer G, Wachter U, Vogt J, et al. Impact of exogenous beta-adrenergic receptor stimulation on hepato-splanchnic oxygen kinetics and metabolic activity in septic shock. Crit Care Med 1999;27:325-31.
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