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Clinical Investigations in Critical CareNorepinephrine or Dopamine for the Treatment of Hyperdynamic Septic Shock?
Section snippets
METHODS
This prospective, randomized, double-blind study included 32 consecutive patients presenting with hyperdynamic septic shock. The study received approval of the Ethics Committee of our Institution, and written informed consent was obtained from a close relative. Hyperdynamic septic shock was defined as follows: (1) systolic blood pressure (SBP) of less than 90 mm Hg; (2) CI of more than 4.0 L/min/m2; (3) decreased organ perfusion as evidenced by altered mental status (prior to sedation) and/or
RESULTS
Thirty-two patients were included in the study. Table 1 shows that at the time of inclusion in the study, no difference was observed between the two groups with regard to clinical data of the 32 patients. Table 2 shows that at the time of inclusion to the study, no difference was observed between the two groups with regard to hemodynamic and metabolic parameters (baseline values). With the use of dopamine, 10 to 25 µg/kg/min, only 5 of 16 patients (31 percent) were successfully treated and
DISCUSSION
The main result of the present study is that, at the dosages tested, norepinephrine was more efficient and reliable than dopamine to reverse the hemodynamic abnormalities seen in hyperdynamic septic shock. Norepinephrine was also capable of being active when high-dose dopamine (25 μg/kg/min) failed. The traditional treatment of hemodynamic abnormalities of septic shock includes restoration of intravascular volume by fluid infusion and the use of adrenergic drugs if hypotension persists despite
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Manuscript received September 16; revision accepted November 25.