title: Effects of norepinephrine on right ventricular function in septic shock patients.
abstract: OBJECTIVE
  To study the effects of norepinephrine on right ventricular function in patients with hyperdynamic septic shock.
  
  
  METHODS
  Prospective, open study.
  
  
  METHODS
  A 15 bed ICU in a university hospital.
  
  
  METHODS
  9 patients with hyperdynamic septic shock (SBP < 90 mmHg, Cl > or = 4 l.min-1.m-2, SVRI < or = 850 dynes.s.cm-5m-2 and oliguria).
  
  
  METHODS
  Plasma volume expansion was used to correct a suspected volume deficit and then, norepinephrine infusion was started and titrated to restore systemic blood pressure to the normal range (mean infusion rate: 1.1 +/- 0.2 mcg.kg-1.min-1). Norepinephrine was the only vasoactive agent used in these patients.
  
  
  RESULTS
  A modified Swan-Ganz catheter mounted with a fast response thermistor was inserted in each patient, allowing repeated measurements of RVEDVI and RVEF. At time of inclusion to the study, all but one patient had elevated MPAP (23 +/- 4 mmHg) and RVEF < or = 50%, and all patients had RVEDVI > or = 90 ml.m-2. During norepinephrine infusion, MAP increased from 51 +/- 9 to 89 +/- 10 mmHg (p < 0.0001), PVRI increased from 204 +/- 35 to 286 +/- 63 dynes.s.cm-5.m-2 (p < 0.05), and despite this increase in right ventricular afterload, no detrimental effect in RVEF (36 +/- 11 to 36 +/- 10%) or in RVEDVI (116 +/- 30 to 127 +/- 40 ml.m-2) was observed. A Frank-Starling relationship for the right ventricle was constructed by plotting an index of ventricular performance (RVSWI) against an index of ventricular preload (RVEDVI). A significant upward shift to the right of the relationship was observed during norepinephrine infusion.
  
  
  CONCLUSIONS
  It was concluded that norepinephrine exerted a favourable effect on right ventricular function.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Hôpital Nord, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Martin
authors.forename: G
authors.initials: G
authors.lastname: Perrin
authors.forename: P
authors.initials: P
authors.lastname: Saux
authors.forename: L
authors.initials: L
authors.lastname: Papazian
authors.forename: F
authors.initials: F
authors.lastname: Gouin
mesh_terms: D000328:Adult; D000368:Aged; D016903:Drug Monitoring; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009638:Norepinephrine / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D015996:Survival Rate; D013815:Thermodilution; D016278:Ventricular Function, Right / Q000187:drug effects*
chemical_list: D009638:Norepinephrine