title: Norepinephrine supplemented with dobutamine or epinephrine for the cardiovascular support of patients with septic shock.
abstract: OBJECTIVE
  Sepsis management remains a great challenge for intensive care medicine. The aim of this study was to evaluate the effect of adding dobutamine versus epinephrine to norepinephrine in treating septic shock patients refractory to fluid therapy.
  
  
  METHODS
  Sixty adult patients with the diagnosis of septic shock were included in this study. Norepinephrine infusion was started at a dose of 0.05 μg/kg/min, and increased gradually up to 0.1 μg/kg/min. Upon reaching this dose, patients with mean arterial pressure <70 mmHg were further divided randomly into two equal groups. In group I: the patients continued on norepinephrine and dobutamine was added at a starting dose of 3 μg/kg/min and increased in increments of 2 μg/kg/min up to 20 μg/kg/min. In group II: the patients continued on norepinephrine and epinephrine was added in a starting dose of 0.05 μg/kg/ min and increased in increments of 0.03 μg/kg/min up to 0.3 μg/kg/min.
  
  
  RESULTS
  Group II patients developed significantly better cardiovascular parameters, lower arterial pH and higher serum lactate and urine output; however, the 28-day mortality and major adverse effects were comparable in both groups.
  
  
  CONCLUSIONS
  The addition of epinephrine to norepinephrine has positive effects on the cardiovascular parameters but negative results on the serum lactate concentration and systemic pH compared with the addition of dobutamine to norepinephrine.
authors.affiliation: Department of Anesthesiology and ICU, Minoufiya Faculty of Medicine, Egypt.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Mahmoud
authors.forename: Amany S
authors.initials: AS
authors.lastname: Ammar