Abstract
Objective
To study the effects of norepinephrine on right ventricular function in patients with hyperdynamic septic shock.
Design
Prospective, open study.
Setting
A 15 bed ICU in a university hospital.
Patients
9 patients with hyperdynamic septic shock (SBP<90 mmHg, Cl≥4l·min−1·m−2, SVRI≤850 dynes·s·cm−5m−2 and oliguria).
Interventions
Plasma volume expansion was used to correct a suspected volume deficit and then, norepinephrine infusion was started and titrated to restore systemic blood pressure to the normal range (mean infusion rate: 1.1±0.2 mcg·kg−1·min−1). Norepinephrine was the only vasoactive agent used in these patients.
Measurements and results
A modified Swan-Ganz catheter mounted with a fast response thermistor was inserted in each patient, allowing repeated measurements of RVEDVI and RVEF. At time of inclusion to the study, all but one patient had elevated MPAP (23±4 mmHg) and RVEF≤50%, and all patients had RVEDVI≥90 ml·m−2. During norepinephrine infusion, MAP increased from 51±9 to 89±10 mmHg (p<0.0001), PVRI increased from 204±35 to 286±63 dynes·s·cm−5·m−2 (p<0.05), and despite this increase in right ventricular afterload, no detrimental effect in RVEF (36±11 to 36±10%) or in RVEDVI (116±30 to 127±40 ml·m−2) was observed. A Frank-Starling relationship for the right ventricle was constructed by plotting an index of ventricular performance (RVSWI) against an index of ventricular preload (RVEDVI). A significant upward shift to the right of the relationship was observed during norepinephrine infusion.
Conclusion
It was concluded that norepinephrine exerted a favourable effect on right ventricular function.
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Work done at Sainte Marguerite Hospital, Marseille, France
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Martin, C., Perrin, G., Saux, P. et al. Effects of norepinephrine on right ventricular function in septic shock patients. Intensive Care Med 20, 444–447 (1994). https://doi.org/10.1007/BF01710657
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DOI: https://doi.org/10.1007/BF01710657