2021
DOI: 10.1186/s13054-021-03711-5
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Norepinephrine potentiates the efficacy of volume expansion on mean systemic pressure in septic shock

Abstract: Background Through venous contraction, norepinephrine (NE) increases stressed blood volume and mean systemic pressure (Pms) and exerts a “fluid-like” effect. When both fluid and NE are administered, Pms may not only result from the sum of the effects of both drugs. Indeed, norepinephrine may enhance the effects of volume expansion: because fluid dilutes into a more constricted, smaller, venous network, fluid may increase Pms to a larger extent at a higher than at a lower dose of NE. We tested t… Show more

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Cited by 28 publications
(18 citation statements)
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“…The fluid-induced increase in stressed blood volume occurs when fluid is administered in a constricted venous network rather than in a large, dilated venous tank. This is what is suggested by a study in septic shock patients, showing that PLR increases Pmsf to a larger extent at a higher than at a lower dose of norepinephrine [ 62 ].…”
Section: How Can the Physiology Of Venous Return Change Practice?supporting
confidence: 83%
“…The fluid-induced increase in stressed blood volume occurs when fluid is administered in a constricted venous network rather than in a large, dilated venous tank. This is what is suggested by a study in septic shock patients, showing that PLR increases Pmsf to a larger extent at a higher than at a lower dose of norepinephrine [ 62 ].…”
Section: How Can the Physiology Of Venous Return Change Practice?supporting
confidence: 83%
“…Besides the increase in arterial pressures, left ventricular afterload and cardiac filling pressures, norepinephrine also increases the venous return, resulting in an increase in right atrial pressure and cardiac preload ( 76 , 77 ). This increase in venous return results from the increase in mean systemic filling pressure ( 78 , 79 ) and thus in venous return pressure gradient. Through its β1 stimulation, norepinephrine also exerts a positive inotropic effect and an increase in stroke volume.…”
Section: Discussion and Review Of The Different Available Vasopressorsmentioning
confidence: 99%
“…For example, in current sepsis resuscitation, first fluids are administered and subsequently (after >2 L of fluids is added in a normal sized adult patient), a vasopressor is started. Based on a Guytonian approach to the circulation, however, it would make more sense to start a vasopressor earlier in the treatment to recruit unstressed to the stressed volume ( Adda et al, 2021 ; Persichini et al, 2022 ). Recruiting unstressed to stressed volume is an important survival mechanism of the human body.…”
Section: Discussionmentioning
confidence: 99%
“…Vs provides information on the effective circulating volume, a hemodynamic variable that is missing in current clinical practice. MSFP has helped to better understand the effects of vasopressors, propofol, and hyperoxia ( Maas et al, 2013 ; de Wit et al, 2016 ; Helmerhorst et al, 2017 ; Adda et al, 2021 ). MSFP and the derived parameters could potentially be beneficial to guide hemodynamic care in patients admitted to the intensive care unit (ICU) ( Rothe, 1993 ; Vos et al, 2020 ; Persichini et al, 2022 ).…”
Section: Introductionmentioning
confidence: 99%