Effects of norepinephrine on right ventricular function in septic shock patients.
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.
Martin
C
C
Department of Anaesthesia and Intensive Care Medicine, Hôpital Nord, Marseille, France.
Perrin
G
G
Saux
P
P
Papazian
L
L
Gouin
F
F
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*
D009638:Norepinephrine