Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine-resistant septic shock.
The hemodynamic effects of epinephrine were prospectively studied in 13 patients with septic shock who remained hypotensive after both fluid loading and dopamine. Hemodynamic measurements were performed before and one hour after the start of epinephrine infusion. Systolic, diastolic, and mean arterial pressure increased in all patients (p less than 0.01). Cardiac index and systemic vascular resistance increased by 34 and 32 percent, respectively (p less than 0.05), but heart rate and pulmonary vascular resistance remained unchanged. There was a concomitant increase in oxygen delivery (p less than 0.01) and oxygen consumption (p less than 0.05), the magnitude of the latter being related to baseline lactacidemia (p less than 0.01). In view of the generally recognized physiologic goals of septic shock management, we conclude that epinephrine could be an appropriate alternative where fluid loading and dopamine have failed.
Service de Reanimation Médicale, Centre Hospitalier Regional et Universitaire, Nancy, France.
P E
PE
Bollaert
P
P
Bauer
G
G
Audibert
H
H
Lambert
A
A
Larcan
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D004298:Dopamine / Q000627:therapeutic use*; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects*; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy
D007773:Lactates; D019344:Lactic Acid; D004298:Dopamine; D004837:Epinephrine