title: Refractory septic shock: efficacy and safety of very high doses of norepinephrine.
abstract: The aim of this study was to evaluate the safety, efficacy, and effects of administration of very high doses of norepinephrine (> 4 microg kg(-1) min(-1)) in catecholamine-resistant septic shock. We reviewed the charts of all patients with nonresponding to commonly used norepinephrine doses (< or = 4 microg kg(-1) min(-1)) septic shock from January 1999 to December 2002 in our Surgical Intensive Care Unit. All patients were treated with high norepinephrine doses (> 4 microg kg(-1) min(-1)), after initial resuscitation, so as to achieve a mean arterial pressure higher than or equal to 65 mmHg. During this 4-year period, 12 consecutive patients with catecholamine-resistant septic shock were included in our study. When compared with the values obtained prior to the administration of very high norepinephrine doses, the values of mean arterial pressure (p = 0.003) and systemic vascular resistance (p = 0.002) significantly increased after the administration of such doses, and additionally, lactate concentrations (p = 0.003) decreased. In contrast, no significant changes were observed regarding mean central venous pressure, pulmonary capillary wedge pressure, and pulmonary arterial pressure. Administration of high norepinephrine doses in our patients resulted in a survival rate of 33.4%. Management of catecholamine-resistant septic shock patients poses a challenging problem. Administration of very high norepinephrine doses is safe and effective and may improve survival of these patients with otherwise extremely high mortality rates.
authors.affiliation: Surgical Intensive Care Unit, First Department of Propaedeutic Surgery, Athens Medical School, University of Athens, Hippocratio Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Katsaragakis
authors.forename: A
authors.initials: A
authors.lastname: Kapralou
authors.forename: D
authors.initials: D
authors.lastname: Theodorou
authors.forename: H
authors.initials: H
authors.lastname: Markogiannakis
authors.forename: A
authors.initials: A
authors.lastname: Larentzakis
authors.forename: K M
authors.initials: KM
authors.lastname: Stamou
authors.forename: P
authors.initials: P
authors.lastname: Drimousis
authors.forename: I
authors.initials: I
authors.lastname: Bramis
mesh_terms: D018806:APACHE; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000145:classification / Q000188:drug therapy* / Q000401:mortality; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine