Norepinephrine alone versus norepinephrine plus low-dose dopamine: Enhanced renal blood flow with combination pressor therapy

Schaer, Gary L.; Mp, Fink; Je, Parrillo

doi:10.1097/00005373-198602000-00028

Cited by 30 publications

(32 citation statements)

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“…Although cardiac output is usually maintained in volume-resuscitated septic patients, a number of investigators (Parrillo et al, 1990;Holcroft et al, 2001;Parker et al, 1984Parker et al, , 1990) have demonstrated impairment of cardiac function. This myocardial dysfunction is characterized by decreased ejection fraction, ventricular dilation, impaired contractile response to volume loading, and a low peak systolic pressure to end-systolic volume ratio, a load-independent measure of ventricular function (Holcroft et al, 2001;Schaer et al, 1985;Reinelt et al, 1997). Chronic peritoneal sepsis in our model produces a prolonged hyperdynamic stage of sepsis and has clinical relevance (Sam II et al, 1997).…”

Section: Discussionmentioning

confidence: 98%

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Chopra

Sharma

2007

Life Sciences

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We hypothesized that progressive decline in myocardial performance would correlate with upregulation of markers for apoptotic mechanisms following increased duration of polymicrobial sepsis in the rat. Male Sprague-Dawley rats (350-400 g) were randomized into sham, 1-, 3-and 7-day sepsis groups. Each septic rat received 200 mg/kg cecal inoculum intraperitoneally (i.p). The post-mortem analysis showed a severely inflamed peritoneum with the presence of pus in all septic animals that was directly proportional to the duration of sepsis. We observed 10, 33 and 42% mortality in the 1-, 3-and 7-day sepsis groups, respectively. Septic animals at 3 and 7 days exhibited an increased wet lung/total body weight and heart weight/total body weight. A significant increase in total cardiac troponin I (cTnI) and C Reactive Protein (CRP) and endothelin-1 (ET-1) was also observed with an increased duration of sepsis. Myocardial ET-1 concentration in the 7-day postsepsis group was significantly elevated compared to the sham and 1-day post-sepsis groups. Sepsis also produced a significant decrease in the mean arterial pressure in the 7-day post-sepsis group and tachycardia in the 1-, 3-, and 7-day post-sepsis groups compared to the sham group. A significant prolongation of the left ventricular isovolumic relaxation rate constant, tau, and left ventricular enddiastolic pressure in the 1-, 3-and 7-day post-sepsis groups compared to the sham group was observed. In addition, a significant decrease in the rates of left ventricular relaxation (−dP/dt) and contraction (+dP/dt) in the 3-and 7-day post-sepsis groups compared to the sham and 1-day postsepsis group was observed. Sepsis produced a significant upregulation in the expression of myocardial TRADD, cytosolic active caspase-3, the Bax/Bcl 2 ratio, and the mitochondrial release of cytochrome C in the 3-and 7-day post-sepsis groups. We observed a progressive increase in the number of TUNEL positive nuclei, cytosolic caspase-3 activation and co-localization of PARP in the nuclei at 1, 3 and 7 days post-sepsis. These data suggest that the progression of sepsis from 1 day to 3-7 days produce distinct cardiodynamic characteristics with a more profound effect during later stages. The sepsis-induced decline in myocardial performance correlates with the induction of myocardial apoptosis.

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Section: Discussionmentioning

confidence: 98%

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Chopra

Sharma

2007

Life Sciences

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“…In healthy subjects the addition of dopamine to NE indeed results in an enhancement of RBF [4,5,45]. Juste et al [72] also noted a further improvement in urine output after addition of dopamine to NE in septic patients.…”

Section: Is the Association With Dopamine Beneficial?mentioning

confidence: 95%

“…In healthy animals intravenous NE has been shown to result in an increased [11], unchanged [44][45][46][47] or decreased RBF [6,42], whereas in septic animals either an increase [44,47] or the absence of any change [38,39,48,49] have been reported. These divergent results are possibly related to differences in basal sympathetic tone, differences in the administered dose of NE and differences in preload and myocardial contractility resulting in different effects on MAP and CO.…”

Section: Effect On Systemic Hemodynamics and Rbfmentioning

confidence: 99%

Vasopressors and the Kidney

Schetz¹

2002

Blood Purif

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The changes in renal perfusion induced by vasopressors depend on their effects on systemic hemodynamics and renal vascular resistance. Both effects are largely influenced by the patient’s underlying condition such as myocardial contractility and vascular responsiveness. A beneficial effect can be expected if mean arterial pressure increases without decreasing cardiac output and if the effect on renal vascular resistance is less pronounced than on systemic vascular resistance. Acute renal failure is associated with loss of renal autoregulation and sepsis is associated with blood pressures below the autoregulatory threshold. Both conditions might therefore benefit from the administration of vasopressors. Many experimental and clinical data indeed suggest a beneficial effect of norepinephrine on the urine output in sepsis. A beneficial effect on renal function (glomerular filtration) is a less consistent finding suggesting that pressure diuresis might be partially responsible for the pressor-induced diuresis. Administration of vasopressors to patients with oliguria should be considered in fluid-resuscitated patients with distributive shock. Whether other vasopressors offer advantages over norepinephrine requires further investigation.

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“…In the selection of drugs for increasing the blood pressure about shock in recent years, norepinephrine has shown to be effective for improving blood fl ow of the viscera. [8,9] So we used norepinephrine to increase the blood pressure and found that in the hypertransfusion group, CO and HR were significantly increased after blood pressure increased, resulting in DO 2 in this group much higher than that in the control group, then improving tissue oxygen supply. Although VO 2 was increased simultaneously in the hypertransfusion group, ERO 2 was lower than that in the control group, indicating that hypertransfusion was effective to improve the oxygen metabolism.…”

Section: Discussionmentioning

confidence: 99%

Effect of hypertransfusion on the gastrointestinal tract after cardiac arrest in a porcine model

Liu

Wang

2012

World Journal of Emergency Medicine

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Norepinephrine alone versus norepinephrine plus low-dose dopamine: Enhanced renal blood flow with combination pressor therapy

Cited by 30 publications

References 0 publications

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Vasopressors and the Kidney

Effect of hypertransfusion on the gastrointestinal tract after cardiac arrest in a porcine model

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