Comparison of Equipressor Doses of Norepinephrine, Epinephrine, and Phenylephrine on Septic Myocardial Dysfunction

Abstract

Background: Myocardial depression is a frequent event during septic shock and may mimic a cardiogenic shock state with decreased cardiac output. Nevertheless, data are scarce regarding the myocardial effects of vasopressors used to treat hypotension. In this study, the authors compared the effects of three commonly used vasopressors acting on different adrenergic receptors on myocardial function in a rodent model of septic shock, as explored with conductance catheter and positron emission tomography. Methods: Septic shock was induced in rats by peritonitis. Eighteen hours after septic insult, vasopressors were titrated to increase mean arterial pressure by 20% compared with baseline values. Results: We observed that peritonitis was associated with arterial hypotension and systolodiastolic dysfunction. Norepinephrine and epinephrine improved mean arterial pressure, cardiac output, and preload recruitable stroke work, a load-independent measure of systolic function, as well as diastolic function and ventriculoarterial coupling. Heart rate, myocardial oxygen consumption, and arrhythmia incidence were furthermore increased in the epinephrine group. Conversely, phenylephrine, a peripheral ␣-agonist, exhibited

Prevalence and Outcome of Diastolic Dysfunction in Children With Fluid Refractory Septic Shock—A Prospective Observational Study*

“…We used "E" values for defining diastolic dysfunction in our study, as it is mostly independent of both preload and heart rate. It is well known that inotrope therapy may affect myocardial functions (34)(35)(36)(37)(38). More than 40% of the patients in their study were already on inotropes at the time of echocardiography compared to only 14% (eight of 56) in our study.…”

“…It has been shown that aggressive inotropic treatment to boost systemic oxygen consumption increased the prevalence of cardiovascular complications and adversely affected outcome in fluid-resuscitated septic patients (36)(37)(38). It may even be one of the factors contributing to myocardial cell injury in patients with septic shock.…”

Comparison of Initial Vasopressors Used for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

“…However, NE may have some advantages. Several studies, including an experimental model of sepsis and a study of patients requiring blood pressure support following spinal anesthesia, have shown improved cardiac function with NE compared to PE and dose-dependent reductions in cardiac output have been seen with PE [10,14,19]. This reduction in cardiac output may have neurological consequences.…”

Myocardial protection induced by fentanyl in pigs exposed to high‐dose adrenaline

“…5 Previous studies have attempted to use high doses of adrenaline to evaluate its effects on the myocardium, but these studies were investigating the myocardial effects of adrenaline under conditions of anaphylaxis, cardiac arrest and sepsis, situations in which myocardial dysfunction is already present. [5][6][7][8][9] The presence of these conditions could bias the evaluation of the sole effects of a high dose of adrenaline on healthy myocardium. In addition, preexisting heart disease or lesions that occur during cardiac arrest or resuscitation could be a source of bias in these studies.…”