scholarly journals Dynamic arterial elastance predicts mean arterial pressure decrease associated with decreasing norepinephrine dosage in septic shock

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
pp. 14 ◽  
Author(s):  
Pierre-Grégoire Guinot ◽  
Eugénie Bernard ◽  
Mélanie Levrard ◽  
Hervé Dupont ◽  
Emmanuel Lorne
Keyword(s):  
Septic Shock ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Arterial Elastance ◽  
Pressure Decrease

Norepinephrine Dosing in Obese and Nonobese Patients With Septic Shock

2016 ◽  
Vol 25 (1) ◽  
pp. 27-32 ◽  
Author(s):  
John J. Radosevich ◽  
Asad E. Patanwala ◽  
Brian L. Erstad
Keyword(s):  
Body Mass Index ◽  
Septic Shock ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Body Mass ◽  
Secondary Outcome ◽  
Obese Patients ◽  
Hemodynamic Status ◽  
Norepinephrine Infusion ◽  
Nonobese Patients

Background Whether or not norepinephrine infusions for support of hemodynamic status in patients with septic shock should be weight based is unknown. This situation is particularly pertinent in patients who are extremely overweight or obese. Objective To compare dosing requirements and effect of norepinephrine on blood pressure in obese and nonobese patients with septic shock. Methods In a retrospective cohort study, data on adult patients with septic shock who received norepinephrine infusion for support of hemodynamic status in a tertiary care, academic medical center were analyzed. Patients were categorized as obese (body mass index ≥ 30) or nonobese (body mass index < 30). The primary outcome was dosing requirements of norepinephrine at 60 minutes after the start of the infusion. The secondary outcome was the log-transformed ratio of mean arterial pressure to norepinephrine. Results The final cohort consisted of 100 obese and 100 nonobese patients. Mean norepinephrine infusion rate at 60 minutes was 0.09 (SD, 0.08) μg/kg per minute in the obese group and 0.13 (SD, 0.14) μg/kg per minute in the nonobese group (P = .006). The non–weight-based dose at 60 minutes was 9 μg/min in obese patients and 8 μg/min in nonobese patients (P = .72). The log transformed mean arterial pressure to norepinephrine ratio at 60 minutes was 2.5 (SD, 0.9) in obese patients and 2.5 (SD, 0.8) in nonobese patients (P = .54) Conclusions Compared with nonobese patients, obese patients with septic shock require lower weight-based doses of norepinephrine and similar total norepinephrine doses.

Pharmacological modulation of procoagulant microparticles improves haemodynamic dysfunction during septic shock in rats

2014 ◽  
Vol 111 (01) ◽  
pp. 154-164 ◽  
Author(s):  
Su-Emmanuelle Degirmenci ◽  
Fatiha Zobairi ◽  
Asael Berger ◽  
Grégory Meyer ◽  
Mélanie Burban ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Vascular Dysfunction ◽  
Vascular Inflammation ◽  
Activated Protein C ◽  
Resistance Arteries ◽  
Pharmacological Modulation ◽  
Circulating Microparticles ◽  
Haemodynamic Improvement

SummaryCirculating microparticles play a pro-inflammatory and procoagulant detrimental role in the vascular dysfunction of septic shock. It was the objective of this study to investigate mechanisms by which a pharmacological modulation of microparticles could affect vascular dysfunction in a rat model of septic shock. Septic or sham rats were treated by activated protein C (aPC) and resuscitated during 4 hours. Their microparticles were harvested and inoculated to another set of healthy recipient rats. Haemodynamic parameters were monitored, circulating total procoagulant microparticles assessed by prothrombinase assay, and their cell origin characterised. Mesenteric resistance arteries, aorta and heart were harvested for western blotting analysis. We found that a) the amount and phenotype of circulating microparticles were altered in septic rats with an enhanced endothelial, leucocyte and platelet contribution; b) aPC treatment significantly reduced the generation of leucocyte microparticles and norepinephrine requirements to reach the mean arterial pressure target in septic rats; c) Microparticles from untreated septic rats, but not from aPC-treated ones, significantly reduced the healthy recipients’ mean arterial pressure; d) Microparticle thromboxane content and aPC activity were significantly increased in aPC-treated septic rats. In inoculated naïve recipients, microparticles from aPC-treated septic rats prompted reduced NF-κB and cyclooxygenase-2 arterial activation, blunted the generation of pro-inflammatory iNOS and secondarily increased platelet and endothelial microparticles. In conclusion, in this septic shock model, increased circulating levels of procoagulant microparticles led to negative haemodynamic outcomes. Pharmacological treatment by aPC modified the cell origin and levels of circulating microparticles, thereby limiting vascular inflammation and favouring haemodynamic improvement.

Increasing mean arterial pressure in patients with septic shock: effects on oxygen variables and renal function

2005 ◽  
Vol 22 (Supplement 34) ◽  
pp. 177
Author(s):  
M. Leone ◽  
J. Albanèse ◽  
I. Boyadjev ◽  
F. Antonini ◽  
C. Martin
Keyword(s):  
Septic Shock ◽  
Renal Function ◽  
Mean Arterial Pressure ◽  
Arterial Pressure

scholarly journals Effects of mean arterial pressure on arousal in sedated ventilated patients with septic shock: a SEPSISPAM post hoc exploratory study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Youenn Jouan ◽  
Valérie Seegers ◽  
Ferhat Meziani ◽  
Fabien Grelon ◽  
Bruno Megarbane ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Exploratory Study ◽  
Post Hoc ◽  
Ventilated Patients

Impact of Norepinephrine Weight-Based Dosing Compared With Non–Weight-Based Dosing in Achieving Time to Goal Mean Arterial Pressure in Obese Patients With Septic Shock

2016 ◽  
Vol 51 (3) ◽  
pp. 194-202 ◽  
Author(s):  
Nina Vadiei ◽  
Mitchell J. Daley ◽  
Manasa S. Murthy ◽  
Carrie S. Shuman
Keyword(s):  
Septic Shock ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Primary Outcome ◽  
Obese Patients ◽  
First Line ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Norepinephrine Dose ◽  
Goal Map

Background: Currently, a lack of standardization exists in norepinephrine dosing units, the first-line vasopressor for septic shock. Timely achievement of goal mean arterial pressure (MAP) is dependent on optimal vasopressor dosing. Objective: To determine if weight-based dosing (WBD) of norepinephrine leads to earlier time to goal MAP compared with non-WBD in obese patients with septic shock. Methods: This was a retrospective, multicenter cohort study. Patients had a body mass index (BMI) ≥30 kg/m2 and received norepinephrine for septic shock with either a non-WBD strategy (between December 2009 and January 2013) or WBD strategy (between January 2013 and December 2015). The primary outcome was time to goal MAP. Secondary outcomes were norepinephrine duration, dose requirements, and development of treatment-related complications. Results: A total of 287 patients were included (WBD 144; non-WBD 143). There was no difference in median time to goal MAP (WBD 58 minutes, interquartile range [IQR] = 16.8-118.5, vs non-WBD 60 minutes, IQR = 17.5-193.5; P = 0.28). However, there was a difference in median cumulative norepinephrine dose (WBD 12.6 mg, IQR = 4.9-45.9, vs non-WBD 10.5 mg, IQR = 3.9-25.6; P = 0.04) and time to norepinephrine discontinuation (WBD 33 hours, IQR = 15-69, vs non-WBD 27 hours, IQR = 12-51; P = 0.03). There was no difference in rates of atrial fibrillation (WBD 15.3% vs non-WBD 23.7%; P = 0.07) or mortality (WBD 23.6% vs non-WBD 23.1%; P = 0.92). Conclusion: WBD of norepinephrine does not achieve time to goal MAP earlier in obese patients with septic shock. However, WBD may lead to higher norepinephrine cumulative dose requirements and prolonged time until norepinephrine discontinuation.

scholarly journals Clinical Effect of Shenfu Injection in Patients with Septic Shock: A Meta-Analysis and Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Zijun Mou ◽  
Zhengtao Lv ◽  
Yi Li ◽  
Meng Wang ◽  
Qun Xu ◽  
...  
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Conventional Therapy ◽  
Meta Analysis ◽  
Serum Lactate ◽  
Controlled Trials ◽  
Shenfu Injection ◽  
Randomized Controlled

Purpose. To conduct a meta-analysis evaluating the efficacy of Shenfu injection for treating patients with septic shock when compared with conventional therapy.Methods. Eight databases including Pubmed, EMBASE, Cochrane Library, ISI Web of Science, CNKI, Wanfang, VIP, and CBM were searched up to October 2014. Randomized controlled trials assessing the efficacy of Shenfu injection were identified. Mean arterial pressure, heart rate, lactate, and mortality were included as outcome measurements.Results. We analyzed data from 12 randomized controlled trials involving 904 participants. Compared with conventional therapy, Shenfu injection could further increase the mean arterial pressure at 1 hour (SMD 0.38; 95% CI, 0.01–0.74) and 6 hours (SMD 0.82; 95% CI, 0.03–1.61). Shenfu injection could further normalize heart rate at 6 hours (SMD −0.90; 95% CI, −1.47–0.33) and clear serum lactate at 6 hours (SMD −0.51; 95% CI, −0.70–0.32) and 24 hours (SMD, 0.52; 95% CI, −0.77–0.26). As the endpoint of mortality was not unified, it was not meta-analyzed.Conclusions. Based on the findings in present review, Shenfu injection is more effective than conventional therapy in increasing mean arterial pressure, normalizing heart rate, clearing serum lactate, and reducing mortality. These results should be confirmed in higher level clinical trials in the future.

Optimal Adrenergic Support in Septic Shock Due to Peritonitis

2003 ◽  
Vol 98 (4) ◽  
pp. 888-896 ◽  
Author(s):  
Qinghua Sun ◽  
Zizhi Tu ◽  
Suzana Lobo ◽  
George Dimopoulos ◽  
Nathalie Nagy ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Blood Lactate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
The Other ◽  
Control Group ◽  
Lower Blood

Background The authors evaluated optimal adrenergic support using norepinephrine, dopamine, and dobutamine in a clinically relevant model of septic shock. Methods Twenty-eight mature, female, anesthetized sheep (weight, 30.5 +/- 3.6 kg) underwent cecal ligation and perforation and were randomized into four groups of seven animals to be treated with norepinephrine, dopamine-norepinephrine, dobutamine-norepinephrine, or no adrenergic agent. In all groups, lactated Ringer's solution was administered to restore cardiac filling pressures to baseline. In the norepinephrine group, norepinephrine (0.5-5 microg. kg(-1). min(-1)) was titrated to maintain mean arterial pressure between 75-85 mmHg. In the dopamine-norepinephrine group, dopamine was given first, and norepinephrine was added only when mean arterial pressure remained below 75 mmHg despite the infusion of 20 microg. kg(-1). min(-1) dopamine. In the dobutamine-norepinephrine group, dobutamine was started at the same time as norepinephrine and titrated up to 20 microg. kg(-1). min(-1) to get a 15% increase in cardiac output. Results The dobutamine-norepinephrine group had greater cardiac output; superior mesenteric blood flow, oxygen delivery (Do(2)), and oxygen consumption ([OV0312]o(2)); and lower blood lactate concentration and partial pressure of carbon dioxide (Pco(2)) gap than the controls did. Cumulative urine output was significantly higher in the dobutamine-norepinephrine group than in the other groups. Survival time was significantly longer in the dobutamine-norepinephrine (24 +/- 4 h), dopamine- norepinephrine (24 +/- 6 h), and norepinephrine (20 +/- 1 h) groups than the control group (17 +/- 2 h; P < 0.05 vs. other groups), and significantly longer in the combined dopamine-norepinephrine and dobutamine-norepinephrine groups (24 +/- 5 h) than in the norepinephrine alone group (P < 0.05). Histologic examination of lung biopsies revealed less severe lesions in the dobutamine-norepinephrine group than in the control and norepinephrine alone groups. Anatomic alterations in the lung, liver, and small intestine were less severe in the dobutamine-norepinephrine group than in the other groups. Conclusions In this prolonged septic shock model, association of norepinephrine with either dopamine or dobutamine resulted in the longest survival and the least severe pulmonary lesions. The combination of dobutamine with norepinephrine was associated with a better myocardial performance, greater Do(2) and [OV0312]o(2), lower blood lactate concentration and Pco(2) gap, and less anatomic injury.

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