Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study*

Lévy, Bruno; Perez, Pierre; Perny, Jessica; Thivilier, Carine; Gérard, Alain

doi:10.1097/ccm.0b013e3181ffe0eb

Cited by 238 publications

(194 citation statements)

References 18 publications

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“…However, a combined use of sympathomimetic agents is frequently employed in ICU patients in order to improve the systemic hemodynamic effects. Norepinephrine and dobutamine have been shown to be a safer strategy than monotherapy with epinephrine in patients with cardiogenic shock in terms of lactic acidosis, heart rate, and arrhythmia (25). Also, no difference was found between the efficacy and safety of epinephrine and polytherapy with norepinephrine and dobutamine in patients with septic shock (26).…”

Section: Discussionmentioning

confidence: 81%

Potential drug–drug interactions in a medical intensive care unit of a university hospital

M¹,

Kucukibrahimoglu²,

Karaalp³

et al. 2016

Turk J Med Sci

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Section: Discussionmentioning

confidence: 81%

Potential drug–drug interactions in a medical intensive care unit of a university hospital

M¹,

Kucukibrahimoglu²,

Karaalp³

et al. 2016

Turk J Med Sci

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“…Rationale: A small, open, randomized interventional study 21 evaluated two different therapies in acute heart failure without evidence of acute cardiac ischemia (epinephrine alone versus norepinephrine and dobutamine). Treatment with epinephrine is associated with a transient lactic acidosis, tachycardia, higher incident of arrhythmia, and inadequate gastric mucosa perfusion.…”

Section: Statement: Epinephrine Increases Metabolic Abnormalities Commentioning

confidence: 99%

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Djogovic

MacDonald

Wensel

et al. 2015

CJEM

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“…57,58 Vasopressin is used in patients with noradrenalin doses >0.5 mcg/kg/min. In septic shock, vasopressor deficiency can occur 59 and its supplementation is safe [60][61][62] with a catecholamine sparing effect.…”

Section: Maintain Perfusion Pressurementioning

confidence: 99%

“…92 In a small pilot study, adrenaline and the combination of dobutamine-noradrenaline improved both cardiac output and oxygen delivery in patients with cardiogenic shock but a transient lactic acidosis, an increase in insulin requirements, impairments in gastric mucosa perfusion, (supra-)ventricular arrhythmia and an increased myocardial oxygen consumption were observed in the adrenaline group. 57 The adrenaline-induced increase in lactate levels may mislead to excessive fluid loading or other potentially harmful shock therapies. 57 Milrinone is a phosphodiesterase type III inhibitor and augments the intracellular concentration of cAMP.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Hauffe¹,

Krüger²,

Béttex³

et al. 2015

Cardiac Failure Review

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Shock in cardio-surgical intensive care unit (ICU) patients is a serious condition with a high morbidity and mortality.1,2 Prompt identification of the underlying conditions and correct management of the lifethreatening physiological deteriorations are crucial to save the patient's life. In daily practice, however, focusing on the main goal -to provide adequate oxygen delivery thereby preventing further organ damage -is often difficult due to multiple influences, distractions, and pending results. Hence, the setting up of priorities is necessary.In addition, many questions arise on how to optimally treat patients in shock: What blood pressure should we target? What fluid should we use and how much? Which vasoactive drug is best and which inotrope? While discussions about these issues can be very fruitful for experts, they risk confusing younger colleagues and nurses at the bedside. Disputes about controversial therapy opinions might consequently delay adequate resuscitation, putting the patient at risk of an adverse outcome. This review aims to give recommendations for the management during the early phase of shock of cardio-surgical patients hospitalised in the ICU. The focus is on the first 6 hours, which are also called 'the golden hours'. Methods Clinical SettingThe cardio-surgical ICU at the University Hospital Zurich is a 12-bed, high-intensity unit that cares for more than 1,100 patients every year.The majority of these critically ill patients undergo cardiac and/or major vascular surgery, most of them being mechanically ventilated and on inotrope/vasopressor support. The unit is part of a successful heart failure programme that includes extracorporeal life support, ventricular assist devices and a heart transplantation service. In order to optimise the initial resuscitation of patients and to avoid adverse effects of inadequate treatment, the consultants of the unit have agreed on treatment recommendations, which are presented here.They are based on current evidence and complemented by clinical experience in areas of uncertainty. Data ExtractionFor this narrative review, a search of the PubMed database and a review of bibliographies from selected articles were performed to identify original data relating to this topic. Key words used for the search were 'shock', 'cardiac surgery', 'critical care', 'inotropes', 'inotropic therapy', 'circulatory support', 'cardiogenic shock' and 'sepsis'. National and international guidelines were reviewed and integrated, e.g. The 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation, 3 The 2014 ESC/ EACTS guidelines on myocardial revascularization 4 and The Surviving Sepsis Campaign guidelines 5 . Articles were scrutinised regarding their study design, population evaluated, interventions, outcomes, and limitations. Finally, personal recommendations were included and highlighted as such to give a comprehensive overview on this topic. Rationale for an Early Management of ShockShock in patients under...

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Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study*

Cited by 238 publications

References 18 publications

Potential drug–drug interactions in a medical intensive care unit of a university hospital

Potential drug–drug interactions in a medical intensive care unit of a university hospital

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

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