title: Hemodynamic effects of titrated norepinephrine in healthy versus endotoxemic sheep.
abstract: In patients with sepsis and systemic inflammatory response syndrome, hemodynamic support is often complicated by a vascular hyporesponsiveness to exogenously administered norepinephrine. Although norepinephrine tachyphylaxis represents a significant clinical problem, the relationship between norepinephrine dosages and mean arterial pressure (MAP) in the presence of systemic inflammation is still not fully understood. This study was, therefore, designed as a prospective, controlled laboratory trial to elucidate the hemodynamic response to incremental norepinephrine doses in healthy and endotoxemic sheep. ANOVA demonstrated that a significantly higher mean infusion rate of norepinephrine was needed to increase MAP by 20 mmHg in endotoxemic versus healthy control sheep (P = 0.007). Whereas the goal-MAP was reached in 100% of healthy controls, it was achieved in only 80% during endotoxemia. Cardiac index increased significantly in healthy, but not in endotoxemic, sheep. Our findings confirm the presence of vascular hyporesponsiveness to norepinephrine in endotoxemia. In addition, this study demonstrates that the presence of systemic inflammation leads to an early hyporesponsiveness against norepinephrine which was caused by a drug-independent mechanism rather than a tachyphylaxis due to long-term administration of norepinephrine.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Muenster, Muenster, Germany. lange-m@anit.uni
authors.forename: Matthias
authors.initials: M
authors.lastname: Lange
authors.forename: Katrin
authors.initials: K
authors.lastname: Bröking
authors.forename: Christoph
authors.initials: C
authors.lastname: Hucklenbruch
authors.forename: Christian
authors.initials: C
authors.lastname: Ertmer
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.forename: Martin
authors.initials: M
authors.lastname: Lücke
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Bone
authors.forename: Martin
authors.initials: M
authors.lastname: Westphal
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019446:Endotoxemia / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D004731:Endotoxins / Q000494:pharmacology; D009638:Norepinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D012486:Salmonella typhimurium; D012756:Sheep; D014655:Vascular Resistance / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D004731:Endotoxins; D014662:Vasoconstrictor Agents; D009638:Norepinephrine