Norepinephrine in septic patients--friend or foe?
Norepinephrine (NE) is mostly used to treat severe hypotension. However, NE has potentially adverse vasoconstrictive effects on regional vascular beds of kidney, liver, and gut, with a potential for ensuing organ dysfunction. NE therefore is considered as a last reserve in otherwise refractory hypotension. During sepsis, a loss of catecholamine responsiveness occurs that is often interpreted as down-regulation of catecholamine receptors. Therefore, the doses of NE needed to maintain or restore blood pressure may be extremely high. Surprisingly, no adverse vasoconstriction with subsequent hypoperfusion occurs during sepsis, despite the high doses of NE administered. Instead, NE rather causes an increase in blood flow and oxygen delivery.
Theilmeier
Gregor
G
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.
Booke
Michael
M
D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D009638:Norepinephrine / Q000009:adverse effects / Q000502:physiology / Q000627:therapeutic use*; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D009638:Norepinephrine