Effects of epinephrine compared with the combination of dobutamine and norepinephrine on gastric perfusion in septic shock

Séguin, Philippe; Bellissant, Éric; Tulzo, Yves Le; Laviolle, Bruno; Lessard, Yvon; Thomas, Rémy; Mallédant, Yannick

doi:10.1067/mcp.2002.122471

Cited by 65 publications

(39 citation statements)

References 14 publications

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“…The role of epinephrine in patients with septic shock is unclear. Although studies such as those by Seguin et al 51 and Levy et al 52 have shown a difference in hemodynamic parameters and measures of tissue perfusion, two RCTs comparing norepinephrine (+ dobutamine where indicated) to epinephrine did not show a difference in mortality. 20,53 The 2012 Surviving Sepsis Guidelines recommend the addition of epinephrine to norepinephrine "when [an] additional agent is needed to maintain adequate blood pressure".…”

Section: Question 5: Which Vasopressors and Inotropes Should Be Used mentioning

confidence: 99%

“…68 Earlier studies demonstrated that dobutamine improved cardiac index as well as creatinine clearance and gastric microcirculation. 51,69,70 More recent studies on the use of dobutamine in septic shock also demonstrated an improvement in cardiovascular parameters, but only limited improvement in microcirculation. [71][72][73] Dobutamine was included in Rivers' study of early goal directed therapy.…”

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confidence: 99%

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

Djogovic

MacDonald

Wensel

et al. 2015

CJEM

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Section: Question 5: Which Vasopressors and Inotropes Should Be Used mentioning

confidence: 99%

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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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“…) has demonstrated beneficial effects in the treatment of septic shock, including improvements in MAP, CI, SVR, oxygen delivery, and gastric mucosal blood flow without detrimental effects on oxygen consumption or lactate levels (40,50). The above studies suggest that there are dose-dependent harmful effects of epinephrine on organ perfusion in humans consistent with the dose-dependent impairment of systemic perfusion and endorgan injury seen in our canine study.…”

mentioning

confidence: 99%

Differing effects of epinephrine, norepinephrine, and vasopressin on survival in a canine model of septic shock

Minneci

Deans²,

Banks³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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. Differing effects of epinephrine, norepinephrine, and vasopressin on survival in a canine model of septic shock. Am J Physiol Heart Circ Physiol 287: H2545-H2554, 2004. First published August 19, 2004 doi:10.1152/ ajpheart.00450.2004.-During sepsis, limited data on the survival effects of vasopressors are available to guide therapy. Therefore, we compared the effects of three vasopressors on survival in a canine septic shock model. Seventy-eight awake dogs infected with differing doses of intraperitoneal Escherichia coli to produce increasing mortality were randomized to receive epinephrine (0.2, 0.8, or 2.0, vasopressin (0.01 or 0.04 U/min), or placebo in addition to antibiotics and fluids. Serial hemodynamic and biochemical variables were measured. Increasing doses of bacteria caused progressively greater decreases in survival (P Ͻ 0.06), mean arterial pressure (MAP) (P Ͻ 0.05), cardiac index (CI) (P Ͻ 0.02), and ejection fraction (EF) (P ϭ 0.02). The effects of epinephrine on survival were significantly different from those of norepinephrine and vasopressin (P ϭ 0.03). Epinephrine had a harmful effect on survival that was significantly related to drug dose (P ϭ 0.02) but not bacterial dose. Norepinephrine and vasopressin had beneficial effects on survival that were similar at all drug and bacteria doses. Compared with concurrent infected controls, epinephrine caused greater decreases in CI, EF, and pH, and greater increases in systemic vascular resistance and serum creatinine than norepinephrine and vasopressin. These epinephrine-induced changes were significantly related to the dose of epinephrine administered. In this study, the effects of vasopressors were independent of severity of infection but dependent on the type and dose of vasopressor used. Epinephrine adversely affected organ function, systemic perfusion, and survival compared with norepinephrine and vasopressin. In the ranges studied, norepinephrine and vasopressin have more favorable risk-benefit profiles than epinephrine during sepsis.vasopressors and systemic perfusion; low cardiac output septic shock; vasopressors and acidosis; vasopressors and cardiac function DESPITE CONTINUED IMPROVEMENTS in medical therapy, mortality from septic shock has remained between 30% and 60% for the past three decades (1, 2). Septic shock is a clinically descriptive term that refers to a pathophysiological state of cardiovascular collapse associated with overwhelming infection. After adequate volume resuscitation, severe septic shock is often characterized by a hyperdynamic state with increased cardiac output (CO), hypotension, and decreased systemic vascular resistance (SVR). However, despite adequate volume resuscitation, 20 -25% of adult septic patients and 50 -60% of pediatric septic patients will present with low CO (3, 33, 34). The majority of septic patients will develop myocardial dysfunction and many will die as a consequence of multiple organ failure (17,35,44). During septic shock, tissue perfusion is compromised by hypotension, by the loss of vascul...

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“…Clinical studies yielded conflicting results with respect to the effect of dobutamine on left ventricular stroke work index, mean arterial pressure and mean pulmonary artery pressure (29)(30)(31)(32)(33) (14). Other studies also failed to draw a definitive conclusion (15,(23)(24)(25).…”

Section: Dobutaminementioning

confidence: 87%

“…It is less commonly used as the first line therapy for septic shock. But there are still many investigations on the effectiveness of epinephrine (14,15,(22)(23)(24)(25)(26). Subjects in these trials were randomized to receive either epinephrine alone or norepinephrine plus dobutamine, because norepinephrine has only moderate effect on the cardiac β1 receptor.…”

Section: Dopamine and Norepinephrinementioning

confidence: 99%

Vasoactive agents for the treatment of sepsis

Zhang

Chen

2016

Ann. Transl. Med.

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The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine. Levosimendan is a relatively new agent exerting its inodilator effect by increasing sensitivity of myocardium to calcium. Some preliminary studies showed a promising result of levosimendan on reducing mortality.

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Effects of epinephrine compared with the combination of dobutamine and norepinephrine on gastric perfusion in septic shock

Abstract: In patients with septic shock, at doses that induced the same mean arterial pressure, epinephrine enhanced more gastric mucosal blood flow than the combination of dobutamine at 5 microg/kg per minute and norepinephrine. This effect was probably a result of higher cardiac index.

Cited by 65 publications

References 14 publications

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

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

Differing effects of epinephrine, norepinephrine, and vasopressin on survival in a canine model of septic shock

Vasoactive agents for the treatment of sepsis

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