title: A comparison of epinephrine and norepinephrine in critically ill patients.
abstract: OBJECTIVE
  To determine whether there was a difference between epinephrine and norepinephrine in achieving a mean arterial pressure (MAP) goal in intensive care (ICU) patients.
  
  
  METHODS
  Prospective, double-blind, randomised-controlled trial.
  
  
  METHODS
  Four Australian university-affiliated multidisciplinary ICUs.
  
  
  METHODS
  Patients who required vasopressors for any cause at randomisation. Patients with septic shock and acute circulatory failure were analysed separately.
  
  
  METHODS
  Blinded infusions of epinephrine or norepinephrine to achieve a MAP >or=70 mmHg for the duration of ICU admission.
  
  
  METHODS
  Primary outcome was achievement of MAP goal >24 h without vasopressors. Secondary outcomes were 28 and 90-day mortality. Two hundred and eighty patients were randomised to receive either epinephrine or norepinephrine. Median time to achieve the MAP goal was 35.1 h (interquartile range (IQR) 13.8-70.4 h) with epinephrine compared to 40.0 h (IQR 14.5-120 h) with norepinephrine (relative risk (RR) 0.88; 95% confidence interval (CI) 0.69-1.12; P = 0.26). There was no difference in the time to achieve MAP goals in the subgroups of patients with severe sepsis (n = 158; RR 0.81; 95% CI 0.59-1.12; P = 0.18) or those with acute circulatory failure (n = 192; RR 0.89; 95% CI 0.62-1.27; P = 0.49) between epinephrine and norepinephrine. Epinephrine was associated with the development of significant but transient metabolic effects that prompted the withdrawal of 18/139 (12.9%) patients from the study by attending clinicians. There was no difference in 28 and 90-day mortality.
  
  
  CONCLUSIONS
  Despite the development of potential drug-related effects with epinephrine, there was no difference in the achievement of a MAP goal between epinephrine and norepinephrine in a heterogenous population of ICU patients.
authors.affiliation: Department of Intensive Care Medicine, The St George Hospital, Gray Street, Kogarah, Sydney 2217, Australia. j.myburgh@unsw.edu.au
authors.forename: John A
authors.initials: JA
authors.lastname: Myburgh
authors.forename: Alisa
authors.initials: A
authors.lastname: Higgins
authors.forename: Alina
authors.initials: A
authors.lastname: Jovanovska
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Naresh
authors.initials: N
authors.lastname: Ramakrishnan
authors.forename: John
authors.initials: J
authors.lastname: Santamaria
mesh_terms: D000368:Aged; D001794:Blood Pressure; D016638:Critical Illness; D004311:Double-Blind Method; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D012772:Shock, Septic / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine; D004837:Epinephrine