Effect of Phenylephrine Push Before Continuous Infusion Norepinephrine in Patients With Septic Shock

Norepinephrine combined with phenylephrine versus norepinephrine in patients with septic shock: a retrospective cohort study

“…The above potential reasons are consistent with the SSC guidelines that do not recommend the use of PE 16 . The same results regarding the increased mortality in PE were also observed in studies by Hawn et al 15 and Patel et al 28 .…”

“…NE has a lesser effect on cardiac output than PE due to its β1-adrenergic agonism. Moreover, a retrospective study found that patients who received PE had a greater decrease in HR over 24 h, which may have resulted in a decrease in cardiac output 15 . The above potential reasons are consistent with the SSC guidelines that do not recommend the use of PE 16 .…”

“…However, it has also been found that PE has the potential to induce splanchnic vasoconstriction 13 , decreased cerebral perfusion 14 , and even an increased mortality risk 15,16 .…”

Reply to: Using small doses of norepinephrine or phenylephrine during the peri-operative period

“…The latest guidelines from the Surviving Sepsis Campaign do not support the use of phenylephrine in this context, and recent evidence suggests that even a short-lived bolus before starting norepinephrine infusion might be harmful. 5 Norepinephrine has also shown similar results to phenylephrine in obstetric anaesthesia, in which the latter is still considered the drug of choice for the treatment of hypotension, with results even slightly in favour of norepinephrine in terms of incidence of maternal bradycardia and foetal pH. 6 In addition, there are indirect data suggesting that phenylephrine could have a worse intestinal, renal or cerebral microvascular profile, although the clinical significance of these findings is not clear.…”

“…Nor should we lose sight of the fact that the evidence in favour of norepinephrine seems to be progressively gaining ground over phenylephrine. The latest guidelines from the Surviving Sepsis Campaign do not support the use of phenylephrine in this context, and recent evidence suggests that even a short-lived bolus before starting norepinephrine infusion might be harmful 5 . Norepinephrine has also shown similar results to phenylephrine in obstetric anaesthesia, in which the latter is still considered the drug of choice for the treatment of hypotension, with results even slightly in favour of norepinephrine in terms of incidence of maternal bradycardia and foetal pH 6 .…”