Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis

Ruslan, Muhammad Azfar; Baharuddin, Kamarul Aryffin; Norhayati, Mohd Noor; Yazid, Mohd Boniami; Noh, Abu Yazid Md; Rahman, Andey

doi:10.5811/westjem.2020.10.47825

Cited by 14 publications

(5 citation statements)

References 32 publications

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“…It has been reported that the use of exogenous epinephrine in the early stages of sepsis is associated with an improved prognosis ( 27 , 28 ) since exogenous epinephrine acts as vasopressor to improve the hemodynamic status of the patient ( 27 ). Furthermore, it has been reported that the exogenous administration of norepinephrine in mice and humans deregulates the immune response and thus it may contribute to the development of sepsis-induced immunoparalysis ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Altered neutrophil-to-lymphocyte ratio in sepsis secondary to canine parvoviral enteritis treated with and without an immunomodulator in puppies

et al. 2022

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Neutrophil-to-lymphocyte ratio (NLR) is a cheap and easy-to-obtain biomarker that mirrors the balance between innate and adaptive immunity. Cortisol and catecholamines have been identified as major drivers of NLR. High cortisol levels increase neutrophils while simultaneously decreasing lymphocyte counts. Likewise, endogenous catecholamines may cause leukocytosis and lymphopenia. Thus, NLR allows us to monitor patient severity in conditions such as sepsis. Twenty-six puppies with sepsis secondary to canine parvoviral enteritis were treated with and without an immunomodulator. Our group determined the NLR and the plasmatic cortisol levels by chemiluminescence, and norepinephrine (NE) and epinephrine (E) by HPLC during the first 72 h of clinical follow-up. Our results showed that at admission puppies presented an NLR value of 1.8, cortisol of 314.9 nmol/L, NE 3.7, and E 3.3 pmol/mL. Both treatments decreased admission NLR values after 24 h of treatment. However, only the puppies treated with the immunomodulator (I) remained without significant changes in NLR (0.7–1.4) compared to the CT group, and that showed a significant difference (P < 0.01) in their NLR value (0.4–4.6). In addition, we found significant differences in the slope values between the admission and final values of NLR (P < 0.005), cortisol (P < 0.02), and E (P < 0.05) between treatments. Then, our data suggest that the immunomodulator positively affects the number of lymphocytes and neutrophils involved in NLR as well as major drivers like cortisol and epinephrine, which is reflected in clinical parameters and survival.

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Section: Discussionmentioning

confidence: 99%

Altered neutrophil-to-lymphocyte ratio in sepsis secondary to canine parvoviral enteritis treated with and without an immunomodulator in puppies

et al. 2022

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“…Basic information included age, gender, name, admission, and outpatient diagnosis, outcome, and treatment. Clinical index information included heart rate, blood pressure, blood routine, blood gas analysis, ventilator tidal volume, positive end-expiratory pressure, plateau pressure, Sequential Organ Failure Assessment (SOFA) score, and acute physiology and chronic health evaluation II (APACHE II) [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Effect Evaluation of Norepinephrine on Cardiac Function in Patients with Sepsis by Cardiac Ultrasound Imaging

Zhou

Yang

et al. 2022

Computational and Mathematical Methods in Medicine

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In order to investigate the therapeutic effect of norepinephrine on patients with sepsis and the effect of echocardiography on the diagnosis of cardiac function in patients with sepsis, 86 patients with sepsis were selected as research objects and randomly divided into two groups. Patients in the control group ( N = 43 cases) received conventional treatment (1~15 μg/ kg ∗ min dopamine), and those in the experimental group ( N = 43 cases) received conventional treatment+norepinephrine therapy (0.05~0.5 μ g ∗ kg -1/min). The clinical efficacy, cardiac ultrasonography results, and hemodynamic indexes of patients between the two groups were analyzed and compared. The results showed that the total effective rate of treatment in the experimental group (97.7%) was significantly higher than that in the control group (81.4%) ( P < 0.05 ). The maximum, minimum, and average values of mitral valve E peak flow velocity (VEpeak) and left ventricular outflow tract peak flow velocity (Vpeak), respiratory variability of mitral valve E peak flow velocity (ΔVEpeak), and respiratory variability of peak flow velocity (ΔVpeak) were all significantly greater than those of the control group ( P < 0.05 ). The area under the receiver operating characteristic curve (AUC) of ΔVEpeak and ΔVpeak for predicting positive volume response in patients with sepsis was 0.934 and 0.913, respectively; the sensitivity was 0.828 and 0.827; the specificity was 0.936 and 0.893; and the Youden indices were 0.765 and 0.712, respectively. In short, norepinephrine had a high total response rate in patients with sepsis, and echocardiography can well evaluate the effect of norepinephrine on cardiac function in patients with sepsis, which is worthy of further promotion.

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“…When alpha1 receptors are activated, norepinephrine's most common side effects occur. In other words, end-organ perfusion can be reduced due to severe vasoconstriction [25] . The baroreceptor reflex can elicit reflex bradycardia as a result of vasoconstriction due to alpha1 activation, and beta1 activity is usually not enough to compensate for this.…”

Section: Adverse Effectsmentioning

confidence: 99%

Noradrenaline versus glypressin for prevention of hypotension after deflation of tourniquet in knee arthroplasty

Eid,

Mostafa,

Abdelrahman

et al. 2024

Int. J. Med. Anesthesiology

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Hypotension, rapid heart rate, and an increased cardiac index are hemodynamic disturbances that can be triggered by a tourniquet's deflation. Patients with impaired cardiovascular function and the elderly are at increased risk due to these changes, even though they may not be noticeable to those with healthy cardiovascular systems. Vasopressor medications work by reversing the effects of sympathetic blockage on the blood vessels. As a result of their actions, venous return and heart filling are preserved and vascular tone is restored. An effective method for managing spinal hypotension is the administration of vasopressors, either by bolus injections or continuous infusion. Researchers are interested in studying the efficacy and safety profiles of norepinephrine and glypressin since they have gained increased attention as possible alternatives for the prevention and treatment of hypotensive episodes.

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Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis

Cited by 14 publications

References 32 publications

Altered neutrophil-to-lymphocyte ratio in sepsis secondary to canine parvoviral enteritis treated with and without an immunomodulator in puppies

Altered neutrophil-to-lymphocyte ratio in sepsis secondary to canine parvoviral enteritis treated with and without an immunomodulator in puppies

Effect Evaluation of Norepinephrine on Cardiac Function in Patients with Sepsis by Cardiac Ultrasound Imaging

Noradrenaline versus glypressin for prevention of hypotension after deflation of tourniquet in knee arthroplasty

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