Septic Shock with cardiovascular support: A major role of norepinephrine supplemented with dobutamine or epinephrine

Dr Chandan Sharma; Dr Akhil Gupta

Authors

Dr Chandan Sharma Physician, Department of Medicine, Government Medical College Jammu, J&K, India
Dr Akhil Gupta Department of Anesthesia, Government Medical College Jammu, Jammu and Kashmir, India

Keywords:

Septic Shock, Norepinephrine, Dobutamine, Epinephrine, Heart Rate, Mean Arterial Pressure, Sequential Organ Failure Assessment

Abstract

Background: Sepsis remains a major challenge, for intensive care medicine. Mortality rates are quite high from sepsis and septic shock. Norepinephrine is considered first drug of choice here, with epinephrine considered for cardiac depression and dobutamine for myocardial depression.

Methods: A prospective, observational, double-blind study was carried out in the Department of Anesthesia, in collaboration with Department of Medicine, GMC Jammu on 60 adult patients, diagnosed of septic shock. Patients were randomly divided into two equal groups for administration of two different set of vasopressor agents: norepinephrine dose with addition of dobutamine or epinephrine under controlled conditions, and various types of parameters were assessed.

Results: Readings of Heart Rates (HR) and Mean Arterial Pressure (MAP) were found to be significantly improving over time. The addition of epinephrine (50-300 µg/kg/min) to morepinephrine (100 µg/kg/min) in patients with septic shock unresponsive to the fluid resuscitation had positive effects on the systemic pH compared with the addition of dobutamine (3-20 ng/kg/min). In both cases Sequential Organ Failure Assessment (SOFA) score showed improvement over time.

Conclusion: The addition of epinephrine to norepinephrine has positive effects on CV parameters but possibly some negative effects on serum lactate also.