Effects of norepinephrine on hemodynamics, vascular elasticity, cardiac pump function, and inflammatory factors in patients with septic shock

Abstract

The effects of norepinephrine on hemodynamics, vascular elasticity, cardiac pump function, and inflammatory factors in patients with septic shock remained unknown. In this study, we included 124 cases of severe septic shock patients in our hospital. The patients were randomly divided into control group (treated with dopamine) and experimental group (treated with dopamine plus norepinephrine), while the hemodynamic index (heart rate (HR)), blood vessel elasticity index, heart pump function, and inflammatory factor index were recorded. After 12 h of treatment, both groups showed decreased HR, increased levels of cardiac index (CI), mean arterial pressure (MAP), central venous pressure (CVP), peripheral vascular resistance index (PVRI), and vascular elasticity (P < 0.05). To date, lower HR, higher levels of CI, MAP, CVP, and PVRI were observed in the experimental group (P < 0.05). Furthermore, the vascular elastic coefficient, stiffness index, arterial compliance, and the precursors of plasma amino-terminal brain natriuretic peptide were also significantly higher in the experimental group than those in the control group (P < 0.05). However, inflammatory cell tumor necrosis factor alpha factor test group (TNF alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6) concentrations were significantly lower than the control group (P < 0.05), compared to experimental group (P < 0.05). This research indicates that phenylephrine could significantly improve hemodynamics in patients with severe septic shock, by maintaining blood vessel elasticity, improving heart pump function, and reducing the inflammatory factors' activities, and this method could be used as a line of vascular tension of the medications used in patients with septic shock.

Physiologic Cardiovascular Studies in Resuscitated Normotensive Septic Shock with Persistent Hyperlactatemia.

“…1). Similar to previous study [10], presumably, increasing NE could convert unstressed volume into stressed volume and causes increasing of VR and cardiac preload as previously mentioned in several studies [10,[25][26][27][28]. However, we found no signi cant difference in Ea/Ees compared between baseline-1 and post-NE while previous study found that NE worsen VA coupling [10].…”

Physiologic cardiovascular studies in resuscitated normotensive septic shock with persistent hyperlactatemia.

“…In addition, we found changing CO also correlated with changing Pvr (Figure 6). Similar to a related study [10], presumably, increasing NE could convert unstressed volume into stressed volume and increasing VR and cardiac preload as mentioned in several studies [10,[25][26][27][28]. However, we found no significant difference in Ea/Ees compared between baseline-1 and postNE while one related study found that NE worsened VA coupling [10].…”

Benefits of esmolol in adults with sepsis and septic shock: An updated meta-analysis of randomized controlled trials

“…The remaining 12 full-text articles were assessed for eligibility, of which 4 articles were further excluded. The remaining 8 RCTs [19,[23][24][25][26][27][28][29] were included in the final meta-analysis.…”

“…Orbegozo Cortes et al [29] and Morelli et al [28] reported the same clinical trial but with different follow-up times. The 7 included 8 RCTs [19,23,24,[26][27][28][29] involving septic shock. Wang et al [25] reported the effect of esmolol and milrinone on patients with severe sepsis, who were randomly divided into control, milrinone, and milrinone-esmolol groups.…”

“…Wang et al [25] reported the effect of esmolol and milrinone on patients with severe sepsis, who were randomly divided into control, milrinone, and milrinone-esmolol groups. Wang et al [24] and Michael et al [19] used saline in control groups, while the remaining studies [23,[26][27][28] used blank controls. Overall, 250 patients were included in esmolol groups, while 253 patients were included in control groups.…”