Change in Myocardial Contractility in Response to Treatment with Norepinephrine in Septic Shock

Innocenti, Francesca; Palmieri, Vittorio; Tassinari, Irene; Capretti, Elisa; Paris, Anna De; Gianno, Adriana; Marchesini, Anna; Montuori, Michele; Pini, Riccardo

doi:10.1164/rccm.202102-0442le

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…We next discuss norepinephrine, emphasizing that it is a potent α-1 agonist with some β-1 activity and, to a much lesser degree, β-2 activity. Therefore, infusions of norepinephrine lead to peripheral vasoconstriction and some positive inotropy, increasing systolic and diastolic blood pressure, peripheral vascular resistance, and left and right ventricular function ( 18 – 20 ). These effects are beneficial in the vasodilatory pathophysiology of septic shock and may also be in the low-flow state of cardiogenic shock.…”

Section: Module 3: Catecholamines and Vasopressorsmentioning

confidence: 99%

Running from a Bear: How We Teach Vasopressors, Adrenoreceptors, and Shock

et al. 2023

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Vasopressors are widely used in the management of shock among critically ill patients. The physiology of vasopressors and adrenoreceptors and their effects on end organs therefore represent important, high-yield topics for learners in the critical care environment. In this report, we describe our approach to teaching this core concept using the stereotypical human physiologic response when running from a bear, in the context of the relevant supporting literature. We use escaping from a threatening predator as a lens to describe the end-organ effects of activating adrenoreceptors together with the effects of endogenous and exogenous catecholamines and vasopressors. After reviewing this foundational physiology, we transition to the clinical environment, reviewing the pathophysiology of various shock states. We then consolidate our teaching by integrating the physiology of adrenoreceptors with the pathophysiology of shock to understand the appropriateness of each therapy to various shock phenotypes. We emphasize to learners the importance of generating a hypothesis about a patient’s physiology, testing that hypothesis with an intervention, and then revising the hypothesis as needed, a critical component in the management of critically ill patients.

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Section: Module 3: Catecholamines and Vasopressorsmentioning

confidence: 99%

Running from a Bear: How We Teach Vasopressors, Adrenoreceptors, and Shock

et al. 2023

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“…[ 7 , 8 ] It exerts a positive inotropic effect on both ventricles via β1 stimulation to a lower extent than its vasopressor activity; this is evidenced by classical load-dependent systolic function parameters [ 5 , 6 , 9 ] and by relatively load-independent parameters such as the left ventricular global longitudinal strain. [ 10 ] Notably, there is limited β1-induced-tachycardia with norepinephrine due to the baroreflex secondary to increased arterial pressure. Therefore, norepinephrine increases cardiac output without increasing the heart rate or myocardial oxygen consumption.…”

Section: Introductionmentioning

confidence: 99%

Alternatives to norepinephrine in septic shock: Which agents and when?

Jozwiak

2022

Journal of Intensive Medicine

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Current practice and evolving concepts in septic shock resuscitation

et al. 2021

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Clinical and pathophysiological understanding of septic shock has progressed exponentially in the previous decades, translating into a steady decrease in septic shock-related morbidity and mortality. Even though large randomized, controlled trials have addressed fundamental aspects of septic shock resuscitation, many questions still exist. In this review, we will describe the current standards of septic shock resuscitation, but the emphasis will be placed on evolving concepts in different domains such as clinical resuscitation targets, adequate use of fluids and vasoactive drugs, refractory shock, and the use of extracorporeal therapies. Multiple research opportunities remain open, and collaborative endeavors should be performed to fill in these gaps.

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Change in Myocardial Contractility in Response to Treatment with Norepinephrine in Septic Shock

Abstract: Hypogammaglobulinemia is associated with increased 1-year mortality in chronic obstructive pulmonary disease [abstract].

Cited by 5 publications

References 12 publications

Running from a Bear: How We Teach Vasopressors, Adrenoreceptors, and Shock

Running from a Bear: How We Teach Vasopressors, Adrenoreceptors, and Shock

Alternatives to norepinephrine in septic shock: Which agents and when?

Current practice and evolving concepts in septic shock resuscitation

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