Abstract
Objective
To compare the effects of norepinephrine and metaraminol on hemodynamics in septic shock patients.
Design and setting
Open-label, controlled clinical trial in the general intensive care unit of a university-affiliated hospital.
Patients and participants
Ten consecutive septic shock patients receiving norepinephrine to maintain the mean arterial pressure higher than 65 mmHg.
Interventions
Patients were monitored with pulmonary artery catheter and indirect calorimetry. At the baseline hemodynamic variables were obtained during norepinephrine infusion. Subsequently norepinephrine was replaced by metaraminol infusion in a dose sufficient to keep mean arterial pressure constant. After 20 min of stable arterial pressure a new set of measurement was repeated.
Measurements and results
Mean arterial pressure did not differ significantly with norepinephrine or metaraminol; there was no relationship between the norepinephrine and metaraminol doses. Replacement norepinephrine with metaraminol did not modify hemodynamic variables; in particular there were no changes in heart rate, stroke volume index, pulmonary artery occlusion pressure, or oxygen consumption index.
Conclusions
This study shows that metaraminol increases arterial pressure as does norepinephrine in septic shock patients. Despite similar effects of norepinephrine and metaraminol, there was no relationship between the dose of the two drugs.
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References
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256
Task Force for Hemodynamic Support of Sepsis in Adult Patients (1999) Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Crit Care Med 27:639–660
Dellinger RP (2003) Cardiovascular management of septic shock. Crit Care Med 31:946–955
Martin C, Papazian L, Perrin G, Saux P, Gouin F (1993) Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 103:1826–1831
De Backer D, Creteur J, Silva E, Vincent JL (2003) Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med 31:1659–1667
Reinelt H, Radermacher P, Kiefer P, Fischer G, Wachter U, Vogt J, Georgieff M (1999) Impact of exogenous beta-adrenoreceptor stimulation on hepato-splanchnic oxygen kinetics and metabolic activity in septic shock. Crit Care Med 27:325–331
Klinzing S, Simon M, Reinhart K, Bredle DL, Meier-Hellmann A (2003) High-dose vasopressin is not superior to norepinephrine in septic shock. Crit Care Med 31:2646–2650
Martin C, Viviand X, Leone M, Thirion X (2000) Effect of norepinephrine on the outcome of septic shock. Crit Care Med 28:2758–2765
Hoffman BB, Lefkowitz RJ (1996) Catecholamines, sympathomimetics drugs, and adrenergic receptor antagonists. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Goodman Gilman A (eds) Goodman & Gilman’s. The pharmacological basis of therapeutics, 9th edn. McGraw-Hill, New York, pp 199–248
Critchley LA, Conway F (1996) Hypotension during subarachnoid anaesthesia: haemodynamic effects of colloid and metaraminol. Br J Anaesth 76:734–736
Ngan Kee WD, Lau TK, Khaw KS, Lee BB (2001) Comparison of metaraminol and ephedrine infusions for maintaining arterial pressure during spinal anesthesia for elective cesarean section. Anesthesiology 95:307–313
Figueras J, Lidon RM, Cortadellas J (1991) Metaraminol-induced reversal of acute myocardial ischaemia associated with hypotension and refractory to intravenous nitroglycerin. Eur Heart J 12:720–725
Sagie A, Sclarovsky S, Klainman E, Strasberg B, Rechavia E, Mager A, Kusniec J, Agmon J (1987) Effect of metaraminol during acute inferior wall myocardial infarction accompanied by hypotension: preliminary study. J Am Coll Cardiol 10:1139–1144
LeDoux D, Astiz ME, Carpati CM, Rackow EC (2000) Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 28:2729–2732
Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-Related Organ Failure Assessment) score to describe the organ dysfunction/failure. Intensive Care Med 22:707–710
Patel BM, Chittock DR, Russell JA, Walley KR (2002) Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 96:576–582
Girbes AR, Patten MT, McCloskey BV, Groeneveld AB, Hoogenberg K (2000) The renal and neurohumoral effects of the addition of low-dose dopamine in septic critically ill patients. Intensive Care Med 26:1685–1689
Sakka SG, Meier-Hellmannn A, Reinhart K (2000) Do fluid administration and reduction in norepinephrine dose improve global and splanchnic haemodynamics? Br J Anaesth 84:758–762
Bucher M, Kees F, Taeger K, Kurtz A (2003) Cytokines down-regulate alpha1-adrenergic receptor expression during endotoxemia. Crit Care Med 31:566–571
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Natalini, G., Schivalocchi, V., Rosano, A. et al. Norepinephrine and metaraminol in septic shock: a comparison of the hemodynamic effects. Intensive Care Med 31, 634–637 (2005). https://doi.org/10.1007/s00134-005-2607-3
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DOI: https://doi.org/10.1007/s00134-005-2607-3