Phenylephrine versus norepinephrine for initial hemodynamic support of patients with septic shock: a randomized, controlled trial

Morelli, Andrea; Ertmer, Christian; Rehberg, Sebastian; Lange, Matthias; Orecchioni, Alessandra; Laderchi, Amalia; Bachetoni, A.; D’Alessandro, Mariadomenica; Aken, Hugo Van; Pietropaoli, P; Westphal, Martin

doi:10.1186/cc7121

Cited by 127 publications

(94 citation statements)

References 34 publications

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“…Among those patients, we selected those whose norepinephrine equivalent (the sum of all vasopressors administered, expressed as equivalent doses of norepinephrine) was Ն 1 m g/kg/min for Ն 10 min. We estimated norepinephrine dose equivalences (e-Table 1) based on prior studies, emphasizing studies in septic adults [8][9][10][11][12] rather than children, 13,14 animal models, 15 or healthy adults. 16 Briefl y, we considered 100 m g dopamine equivalent to 1 m g norepinephrine; 1 m g epinephrine equivalent to 1 m g norepinephrine; and 2.2 m g phenylephrine equivalent to 1 m g norepinephrine.…”

Section: Methodsmentioning

confidence: 99%

Survival After Shock Requiring High-Dose Vasopressor Therapy

Brown

Lanspa

Jones

et al. 2013

Chest

177

149

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Shock is an often lethal syndrome of diminished or insuffi cient perfusion that impairs organ function. Generally associated with decreased arterial blood pressure, shock results most commonly from sepsis, hemorrhage, or primary cardiac failure. 1 Vasopressor medications, largely vasoactive catecholamine hormones, have been used for many decades in the treatment of hypotensive shock. These medications have not been subjected to rigorous, placebo-controlled studies, and consensus from clinical experience suggests that there is not equipoise for such a study in most cases of shock. 2 When vascular tone is profoundly diminished (eg, vasoplegic syndrome or distributive shock), patients may require high-dose vasopressor therapy (HDV).Background: Some patients with hypotensive shock do not respond to usual doses of vasopressor therapy. Very little is known about outcomes after high-dose vasopressor therapy (HDV). We sought to characterize survival among patients with shock requiring HDV. We also evaluated the possible utility of stress-dose corticosteroid therapy in these patients.

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Section: Methodsmentioning

confidence: 99%

Survival After Shock Requiring High-Dose Vasopressor Therapy

Brown

Lanspa

Jones

et al. 2013

Chest

177

149

View full text Add to dashboard Cite

show abstract

“…In patients in septic shock, replacing norepinephrine with phenylephrine lead to decreased creatinine clearance and increased arterial lactate (106). A small trial comparing phenylephrine with norepinephrine as the first-line vasopressor therapy revealed a trend toward higher urine output in the norepinephrine group (107). A comparison between norepinephrine and vasopressin in patients with septic shock showed improved renal function and urine output in the vasopressin groups (108).…”

Section: Vasopressor Selectionmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

258

198

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Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

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“…The pharmacologic properties of phenylephrine make it a less appealing choice during the setting of septic shock. There are trials comparing phenylephrine to norepinephrine in terms of hemodynamic and metabolic parameters showing equivalence 55,56 or inferiority 57 to norepinephrine. A 2011 review by Thiele et al discusses the evidence for the use of phenylephrine, including special situations where it might be the preferred agent.…”

Section: Question 5: Which Vasopressors and Inotropes Should Be Usedmentioning

confidence: 99%