Estudio comparativo entre dopamina y norepinefrina en el manejo del shock séptico
Comparative study of dopamine and norepinephrine in the management of septic shock.
Agrawal A, Gupta A, Consul S, Shastri P.
Department of Internal Medicine, Chattrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
Saudi J Anaesth. 2011 Apr;5(2):162-6.
Abstract
The objective was to compare the ability of norepinephrine and dopamine in reversing the hemodynamic and metabolic abnormalities of septic shock using Edwards Vigileo Monitor with Flotrac Sensor. DESIGN: Prospective randomized control study.METHODS: Fifty consecutive patients presenting with hyperdynamic septic shock who fulfilled the inclusion criteria were randomly allocated to either group I or group II. The goal of therapy was to achieve and maintain for 6 hours, all of the following - systolic blood pressure (SBP) >90 mmHg, systemic vascular resistance index (SVRI) >1800 dynes.s/cm(5)m(2), cardiac index (CI) >4.0 lt/min/m(2), index of oxygen delivery >550 ml/min/m(2), index of oxygen uptake >150 ml/min/m(2). The patients in group I were started on dopamine infusion at 10 μg/kg/min which was increased by 2.5 μg/kg/min, every 15 minutes till the goals were achieved. The patients in group II received norepinephrine infusion started at a dose of 0.5 μg/kg/min with a dose increment of 0.25 μg/kg/min, every 15 minutes till the goals were achieved. RESULTS: Post-treatment heart rate showed an increase in the mean value in group I patients and a decrease in group II patients. The post-treatment mean SBP and SVRI in group II was significantly higher than that in group I. Patients in group I showed a significantly higher increase in post-treatment CI and index of oxygen delivery compared to patients in group II. Nineteen out of 25 patients responded to the treatment in group II while only 10 out of 25 responded in group I. CONCLUSION: Norepinephrine was more useful in reversing the hemodynamic and metabolic abnormalities of hyperdynamic septic shock compared to dopamine.
http://www.saudija.org/temp/SaudiJAnaesh52162-4405277_121412.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139308/
Comparación entre fenilefrina y norepinefrina en el tratamiento de shock séptico resistente a dopamina
Comparison of phenylephrine and norepinephrine in the management of dopamine-resistant septic shock.
Jain G, Singh DK.
Department of Anesthesia, Banaras Hindi University, Varanasi, U.P., India.
Indian J Crit Care Med. 2010 Jan;14(1):29-34.
Abstract
INTRODUCTION: THIS STUDY AIMS TO COMPARE TWO VASOCONSTRICTORS: - norepinephrine and phenylephrine - in the management of dopamine-resistant septic shock. MATERIALS AND METHODS: We performed a randomized, prospective, controlled trial in 54 septic shock patients, with persistent hypotension despite adequate volume resuscitation and continued dopamine infusion ~25mug/kg/h. Patients were randomly allocated into two groups to receive either norepinephrine or phenylephrine infusion (n = 27 each) titrated to achieve a target of SBP > 90mm Hg, MAP > 75 mm Hg, SVRI > 1100 dynes.s/cm5m2, CI > 2.8 L/min/m2, DO2I > 550 ml/min/m2, and VO2I > 150 ml/min/m2 for continuous 6 h. All the parameters were recorded every 30 min and increment in dose of studied drug was done in the specified dose range if targets were not achieved. Data from pulmonary arterial and hepatic vein catheterization, thermodilution catheter, blood gas analysis, blood lactate levels, invasive blood pressure, and oxygen transport variables were compared with baseline values after achieving the targets of therapy. Differences within and between groups were analyzed using a one-way analysis of variance test and Fischer's exact test. RESULTS: No difference was observed in any of the investigated parameters except for statistically significant reduction of heart rate (HR) (P<0.001) and increase in stroke volume index (SVI) (P<0.001) in phenylephrine group as compared to nonsignificant change in norepinephrine group. CONCLUSIONS: Phenylephrine infusion is comparable to norepinephrine in reversing hemodynamic and metabolic abnormalities of sepsis patients, with an additional benefit of decrease in HR and improvement in SVI.
http://www.ijccm.org/article.asp?issn=0972-5229;year=2010;volume=14;issue=1;spage=29;epage=34;aulast=Jain
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Comparative study of dopamine and norepinephrine in the management of septic shock.
Agrawal A, Gupta A, Consul S, Shastri P.
Department of Internal Medicine, Chattrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
Saudi J Anaesth. 2011 Apr;5(2):162-6.
Abstract
The objective was to compare the ability of norepinephrine and dopamine in reversing the hemodynamic and metabolic abnormalities of septic shock using Edwards Vigileo Monitor with Flotrac Sensor. DESIGN: Prospective randomized control study.METHODS: Fifty consecutive patients presenting with hyperdynamic septic shock who fulfilled the inclusion criteria were randomly allocated to either group I or group II. The goal of therapy was to achieve and maintain for 6 hours, all of the following - systolic blood pressure (SBP) >90 mmHg, systemic vascular resistance index (SVRI) >1800 dynes.s/cm(5)m(2), cardiac index (CI) >4.0 lt/min/m(2), index of oxygen delivery >550 ml/min/m(2), index of oxygen uptake >150 ml/min/m(2). The patients in group I were started on dopamine infusion at 10 μg/kg/min which was increased by 2.5 μg/kg/min, every 15 minutes till the goals were achieved. The patients in group II received norepinephrine infusion started at a dose of 0.5 μg/kg/min with a dose increment of 0.25 μg/kg/min, every 15 minutes till the goals were achieved. RESULTS: Post-treatment heart rate showed an increase in the mean value in group I patients and a decrease in group II patients. The post-treatment mean SBP and SVRI in group II was significantly higher than that in group I. Patients in group I showed a significantly higher increase in post-treatment CI and index of oxygen delivery compared to patients in group II. Nineteen out of 25 patients responded to the treatment in group II while only 10 out of 25 responded in group I. CONCLUSION: Norepinephrine was more useful in reversing the hemodynamic and metabolic abnormalities of hyperdynamic septic shock compared to dopamine.
http://www.saudija.org/temp/SaudiJAnaesh52162-4405277_121412.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139308/
Comparación entre fenilefrina y norepinefrina en el tratamiento de shock séptico resistente a dopamina
Comparison of phenylephrine and norepinephrine in the management of dopamine-resistant septic shock.
Jain G, Singh DK.
Department of Anesthesia, Banaras Hindi University, Varanasi, U.P., India.
Indian J Crit Care Med. 2010 Jan;14(1):29-34.
Abstract
INTRODUCTION: THIS STUDY AIMS TO COMPARE TWO VASOCONSTRICTORS: - norepinephrine and phenylephrine - in the management of dopamine-resistant septic shock. MATERIALS AND METHODS: We performed a randomized, prospective, controlled trial in 54 septic shock patients, with persistent hypotension despite adequate volume resuscitation and continued dopamine infusion ~25mug/kg/h. Patients were randomly allocated into two groups to receive either norepinephrine or phenylephrine infusion (n = 27 each) titrated to achieve a target of SBP > 90mm Hg, MAP > 75 mm Hg, SVRI > 1100 dynes.s/cm5m2, CI > 2.8 L/min/m2, DO2I > 550 ml/min/m2, and VO2I > 150 ml/min/m2 for continuous 6 h. All the parameters were recorded every 30 min and increment in dose of studied drug was done in the specified dose range if targets were not achieved. Data from pulmonary arterial and hepatic vein catheterization, thermodilution catheter, blood gas analysis, blood lactate levels, invasive blood pressure, and oxygen transport variables were compared with baseline values after achieving the targets of therapy. Differences within and between groups were analyzed using a one-way analysis of variance test and Fischer's exact test. RESULTS: No difference was observed in any of the investigated parameters except for statistically significant reduction of heart rate (HR) (P<0.001) and increase in stroke volume index (SVI) (P<0.001) in phenylephrine group as compared to nonsignificant change in norepinephrine group. CONCLUSIONS: Phenylephrine infusion is comparable to norepinephrine in reversing hemodynamic and metabolic abnormalities of sepsis patients, with an additional benefit of decrease in HR and improvement in SVI.
http://www.ijccm.org/article.asp?issn=0972-5229;year=2010;volume=14;issue=1;spage=29;epage=34;aulast=Jain
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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