Aminas en shock séptico

Norepinefrina complementada con dobutamina o epinefrina para el apoyo cardiovascular de los pacientes con shock séptico


Norepinephrine supplemented with dobutamine or epinephrine for the cardiovascular support of patients with septic shock.
Mahmoud KM, Ammar AS.
Indian J Crit Care Med [serial online] 2012 [cited 2012 Jul 28];16:75-80.

Background and Aims: 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. Materials and 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.


http://www.ijccm.org/text.asp?2012/16/2/75/99110




Vasopresores e inotrópicos en el tratamiento del shock séptico en humanos: ¿efecto o inmunidad innata?


Vasopressors and inotropes in the treatment of human septic shock: effect on innate immunity?
Hartemink KJ, Groeneveld AB.
Department of Intensive Care and Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.kjhartemink@hetnet.nl
Inflammation. 2012 Feb;35(1):206-13.
Abstract
Catecholamines have been suggested to modulate innate immune responses in experimental settings. The significance hereof in the treatment of human septic shock is unknown. We therefore sought if and how vasopressor/inotropic doses relate to pro-inflammatory mediators during treatment of septic shock. We prospectively studied 20 consecutive septic shock patients. For 3 days after admission, hemodynamic variables, lactate and plasma levels of interleukins (IL)-6 and 8, tumor necrosis factor (TNF)-α, and elastase-α(1)-antitrypsin were measured six hourly. Doses of vasoactive drugs were recorded. Of the 20 patients, nine died in the intensive care unit. Dobutamine doses were positively associated and related to TNF-α plasma levels, independently of disease severity, hemodynamics, and outcome, in multivariable models. Dopamine doses were positively associated with IL-6, and norepinephrine was inversely associated with IL-8 and TNF-α levels. Our observations suggest that catecholamines used in the treatment of human septic shock differ in their potential modulation of the innate immune response to sepsis in vivo. Dobutamine treatment may contribute to circulating TNF-α and dopamine to IL-6, independently of activated neutrophils. Conversely, norepinephrine may lack pro-inflammatory actions.



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282003/pdf/10753

_2011_Article_9306.pdf



Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org