Short-term effects of phenylephrine on systemic and regional hemodynamics in patients with septic shock: a crossover pilot study.
Clinical studies evaluating the use of phenylephrine in septic shock are lacking. The present study was designed as a prospective, crossover pilot study to compare the effects of norepinephrine (NE) and phenylephrine on systemic and regional hemodynamics in patients with catecholamine-dependent septic shock. In 15 septic shock patients, NE (0.82 +/- 0.689 microg x kg(-1) x min(-1)) was replaced with phenylephrine (4.39 +/- 5.23 microg x kg(-1) x min(-1)) titrated to maintain MAP between 65 and 75 mmHg. After 8 h of phenylephrine infusion treatment was switched back to NE. Data from right heart catheterization, acid-base balance, thermo-dye dilution catheter, gastric tonometry, and renal function were obtained before, during, and after replacing NE with phenylephrine. Variables of systemic hemodynamics, global oxygen transport, and acid-base balance remained unchanged after replacing NE with phenylephrine except for a significant decrease in heart rate (phenylephrine, 89 +/- 18 vs. NE, 93 +/- 18 bpm; P < 0.05). However, plasma disappearance rate (phenylephrine, 13.5 +/- 7.1 vs. NE, 16.4 +/- 8.7% x min(-1)) and clearance of indocyanine green (phenylephrine, 330 +/- 197 vs. NE, 380 +/- 227 mL x min(-1) x m(-2)), as well as creatinine clearance (phenylephrine, 81.3 +/- 78.4 vs. NE, 94.3 +/- 93.5 mL x min(-1)) were significantly decreased by phenylephrine infusion (each P < 0.05). In addition, phenylephrine increased arterial lactate concentrations as compared with NE infusion (1.7 +/- 1.0 vs. 1.4 +/- 1.1 mM; P < 0.05). After switching back to NE, all variables returned to values obtained before phenylephrine infusion except creatinine clearance and gastric tonometry values. Our results suggest that for the same MAP, phenylephrine causes a more pronounced hepatosplanchnic vasoconstriction as compared with NE.
Morelli
Andrea
A
Department of Anesthesiology and Intensive Care, University of Rome, La Sapienza, Rome, Italy. andrea.morelli@uniroma1.it
Lange
Matthias
M
Ertmer
Christian
C
Dünser
Martin
M
Rehberg
Sebastian
S
Bachetoni
Alessandra
A
D'Alessandro
Marladomenica
M
Van Aken
Hugo
H
Guarracino
Fabio
F
Pietropaoli
Paolo
P
Traber
Daniel L
DL
Westphal
Martin
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D002395:Catecholamines / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D018592:Cross-Over Studies; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000494:pharmacology / Q000627:therapeutic use; D010656:Phenylephrine / Q000494:pharmacology / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000378:metabolism; D012772:Shock, Septic / Q000188:drug therapy* / Q000378:metabolism; D016896:Treatment Outcome
D002395:Catecholamines; D010656:Phenylephrine; D009638:Norepinephrine