01.08.2010 | Research | Ausgabe 4/2010 Open Access

Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension
- Zeitschrift:
- Critical Care > Ausgabe 4/2010
Electronic supplementary material
Competing interests
Authors' contributions
Introduction
Materials and methods
Patients
Hemodynamic variables
Data analysis
Statistical analysis
Results
Values
|
|
---|---|
Number of patients
|
105
|
Age, years
|
63 ± 12
|
Sex ratio, male/female
|
71/34
|
Mechanically ventilated patients, %
|
86
|
Baseline plasma lactate concentration, mmol/L
|
3.8 ± 1.2
|
SOFA
|
12 ± 2
|
SAPS II
|
57 ± 12
|
Prior hypertension,
n
|
29
|
Prior cardiomyopathy,
n
|
30
|
Baseline left ventricular ejection fraction, %
|
49 ± 10
|
Origin of sepsis
|
|
Lung,
n
|
83
|
Abdomen,
n
|
10
|
Urinary tract,
n
|
8
|
Others,
n
|
4
|
Effects of norepinephrine in the whole population
Before norepinephrine
(introduction/increase)
|
After norepinephrine
(introduction/increase)
|
|
---|---|---|
Heart rate, beats/min
|
98 ± 21
|
97 ± 19
|
MAP, mm Hg
|
54 ± 8
|
76 ± 9
a
|
DAP, mm Hg
|
38 ± 6
|
52 ± 8
a
|
CI, L/min/m
2
|
3.2 ± 1.0
|
3.6 ± 1.1
a
|
SVI, ml/m
2
|
34 ± 12
|
39 ± 13
a
|
GEDVI, ml/m
2
|
694 ± 148
|
742 ± 168
a
|
CFI, per minute
|
4.7 ± 1.5
|
5.0 ± 1.6
a
|
SVRI, dynes/sec/cm
5/m
2
|
1,471 ± 481
|
1,822 ± 502
a
|
Achieved MAP <75 mm Hg
|
Achieved MAP ≥75 mm Hg
|
|||
---|---|---|---|---|
Before NE
(introduction/increase)
|
After NE
(introduction/increase)
|
Before NE
(introduction/increase)
|
After NE
(introduction/increase)
|
|
Heart rate, beats/min
|
103 ± 20
|
101 ± 20
|
93 ± 21
|
94 ± 20
|
MAP, mm Hg
|
51 ± 7
|
68 ± 4
a
|
57 ± 7
|
83 ± 6
a
|
DAP, mm Hg
|
36 ± 7
|
48 ± 7
a
|
40 ± 6
|
56 ± 8
a
|
CI, L/min/m
2
|
3.2 ± 1.1
|
3.6 ± 1.1
a
|
3.2 ± 0.9
|
3.7 ± 1.1
a
|
SVI, ml/m
2
|
32 ± 12
|
37 ± 13
a
|
38 ± 12
|
42 ± 14
a
|
GEDVI, ml/m
2
|
698 ± 139
|
752 ± 161
a
|
691 ± 157
|
743 ± 181
a
|
CFI, per min
|
4.7 ± 1.8
|
4.9 ± 1.7
a
|
4.8 ± 1.3
|
5.1 ± 1.5
a
|
SVRI, dynes/sec/cm
5/m
2
|
1,435 ± 535
|
1,704 ± 592
a
|
1,497 ± 542
|
1,937 ± 582
a
|
Effects of norepinephrine in patients with a baseline LVEF >45%
LVEF ≤45%
|
LVEF >45%
|
|||
---|---|---|---|---|
Before NE
(introduction/increase)
|
After NE
(introduction/increase)
|
Before NE
(introduction/increase)
|
After NE
(introduction/increase)
|
|
Heart rate, beats/min
|
96 ± 17
|
94 ± 17
|
93 ± 21
|
94 ± 20
|
MAP, mm Hg
|
54 ± 9
|
75 ± 9
a
|
54 ± 7
|
76 ± 9
a
|
DAP, mm Hg
|
38 ± 7
|
52 ± 9
a
|
38 ± 6
|
52 ± 8
a
|
CI, L/min/m
2
|
2.9 ± 0.9
|
3.3 ± 0.9
a
|
3.2 ± 0.9
|
3.7 ± 1.1
a
|
SVI, ml/m
2
|
32 ± 11
|
35 ± 12
a
|
36 ± 13
|
41 ± 15
a
|
GEDVI, ml/m
2
|
719 ± 161
|
768 ± 190
a
|
683 ± 140
|
731 ± 157
a
|
CFI, per min
|
4.2 ± 1.4
|
4.4 ± 1.5
|
5.0 ± 1.6
|
5.4 ± 1.6
a
|
SVRI, dynes/sec/cm
5/m
2
|
1,588 ± 513
|
2,024 ± 616
a
|
1,435 ± 484
|
1,680 ± 535
a
|
Achieved MAP <75 mm Hg
|
Achieved MAP ≥75 mm Hg
|
|||
---|---|---|---|---|
Before NE
(introduction/increase)
|
After NE
(introduction/increase)
|
Before NE
(introduction/increase)
|
After NE
(introduction/increase)
|
|
Heart rate, beats/min
|
105 ± 22
|
104 ± 21
|
93 ± 23
|
95 ± 21
|
MAP, mm Hg
|
52 ± 7
|
69 ± 5
a
|
56 ± 6
|
83 ± 6
a
|
DAP, mm Hg
|
37 ± 7
|
48 ± 7
a
|
39 ± 4
|
56 ± 8
a
|
CI, L/min/m
2
|
3.2 ± 1.1
|
3.6 ± 1.1
a
|
3.5 ± 1.1
|
4.1 ± 1.3
a
|
SVI, ml/m
2
|
32 ± 13
|
36 ± 13
a
|
40 ± 12
|
46 ± 15
a
|
GEDVI, ml/m
2
|
674 ± 133
|
731 ± 157
a
|
687 ± 147
|
729 ± 160
a
|
CFI, per min
|
4.8 ± 1.7
|
5.0 ± 1.6
|
5.3 ± 1.7
|
5.8 ± 1.7
a
|
SVRI, dynes/sec/cm
5/m
2
|
1,435 ± 487
|
1,639 ± 486
a
|
1,405 ± 503
|
1,725 ± 577
a
|
Effects of norepinephrine in patients with a baseline LVEF ≤45%
Achieved MAP < 75 mm Hg
|
Achieved MAP ≥75 mm Hg
|
|||
---|---|---|---|---|
Before NE
(introduction/increase)
|
After NE
(introduction/increase)
|
Before NE
(introduction/increase)
|
After NE
(introduction/increase)
|
|
Heart rate, beats/min
|
100 ± 16
|
96 ± 17
|
92 ± 18
|
91 ± 17
|
MAP, mm Hg
|
49 ± 8
|
68 ± 4
a
|
58 ± 8
|
82 ± 7
a
|
DAP, mm Hg
|
36 ± 6
|
48 ± 7
a
|
40 ± 8
|
56 ± 9
a
|
CI, L/min/m
2
|
2.7 ± 0.9
|
3.0 ± 1.0
a
|
3.2 ± 0.8
|
3.4 ± 0.8
|
SVI, ml/m
2
|
28 ± 11
|
33 ± 13
a
|
35 ± 10
|
38 ± 10
|
GEDVI, ml/m
2
|
660 ± 167
|
770 ± 185
a
|
737 ± 157
|
766 ± 201
|
CFI, per min
|
3.9 ± 1.5
|
4.0 ± 1.5
|
4.4 ± 1.2
|
4.6 ± 1.4
|
SVRI, dynes/sec/cm
5/m
2
|
1,654 ± 639
|
1,993 ± 709
a
|
1,523 ± 355
|
2,057 ± 527
a
|
Discussion
Conclusions
Key messages
-
Early administration of norepinephrine aimed at rapidly achieving a sufficient perfusion pressure in severely hypotensive septic-shock patients is able to increase cardiac output.
-
The increase in cardiac output with norepinephrine seems to be related to increases in both cardiac preload and cardiac contractility.
-
These positive effects can be observed even in patients with poor cardiac contractility, except when values of MAP ≥75 mm Hg are achieved.