CoChat
Sign Up
Cited by 368Sepsis Diagnosis and TreatmentHemodynamic Monitoring and TherapyHeart Failure Treatment and Management

A comparison of epinephrine and norepinephrine in critically ill patients

Myburgh, John A., Higgins, Alisa, Jovanovska, Alina, Lipman, Jeffrey, Ramakrishnan, Naresh, Santamaria, John, the CAT Study investigators·2008·Intensive Care Medicine
DOI 10.1007/s00134-008-1219-0
Open this paper in CoChat — free account

Abstract

Objective To determine whether there was a difference between epinephrine and norepinephrine in achieving a mean arterial pressure (MAP) goal in intensive care (ICU) patients.Design Prospective, double-blind, randomised-controlled trial.Setting Four Australian university-affiliated multidisciplinary ICUs.Patients and participants Patients who required vasopressors for any cause at randomisation. Patients with septic shock and acute circulatory failure were analysed separately.Interventions Blinded infusions of epinephrine or norepinephrine to achieve a MAP >or=70 mmHg for the duration of ICU admission.Measurements Primary outcome was achievement of MAP goal >24 h without vasopressors. Secondary outcomes were 28 and 90-day mortality. Two hundred and eighty patients were randomised to receive either epinephrine or norepinephrine. Median time to achieve the MAP goal was 35.1 h (interquartile range (IQR) 13.8-70.4 h) with epinephrine compared to 40.0 h (IQR 14.5-120 h) with norepinephrine (relative risk (RR) 0.88; 95% confidence interval (CI) 0.69-1.12; P = 0.26). There was no difference in the time to achieve MAP goals in the subgroups of patients with severe sepsis (n = 158; RR 0.81; 95% CI 0.59-1.12; P = 0.18) or those with acute circulatory failure (n = 192; RR 0.89; 95% CI 0.62-1.27; P = 0.49) between epinephrine and norepinephrine. Epinephrine was associated with the development of significant but transient metabolic effects that prompted the withdrawal of 18/139 (12.9%) patients from the study by attending clinicians. There was no difference in 28 and 90-day mortality.Conclusions Despite the development of potential drug-related effects with epinephrine, there was no difference in the achievement of a MAP goal between epinephrine and norepinephrine in a heterogenous population of ICU patients.

Integrity signals

Registry

Crossref · 10.1007/s00134-008-1219-0

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A randomized blinded study comparing epinephrine with norepinephrine in shock found no difference in 90-day mortality and vasopressor-free days.

    “A randomised blinded study comparing epinephrine with norepinephrine in patients with shock showed no difference in 90-day mortality (HR 0.88; 95% CI 0.63–1.25) and vasopressor-free days [351].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [351]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Myburgh, J. A., Higgins, A., Jovanovska, A., Lipman, J., Ramakrishnan, N., Santamaria, J., & the CAT Study investigators
Affiliations
  • St George Hospital (AU)
  • Monash University (AU)
  • The University of Queensland (AU)
  • Royal North Shore Hospital (AU)
  • St Vincent's Hospital Melbourne (AU)
Corresponding author
Myburgh, John A.
ORCID
Venue
Intensive Care Medicine
Publisher
Springer Science and Business Media LLC
Published
2008-07-25
Volume
34
Issue
12
Pages
2226-2234
ISSN
  • 0342-4642 (ISSN-L)
  • 1432-1238
DOI
10.1007/s00134-008-1219-0
OpenAlex
W2066473574
Cited by
368
References
27
Citations by year
2026: 10 · 2025: 34 · 2024: 24 · 2023: 23 · 2022: 26 · 2021: 30 · 2020: 19 · 2019: 33 · 2018: 18 · 2017: 20 · 2016: 24 · 2015: 19 · 2014: 25 · 2013: 14 · 2012: 9
FWCI
9.68
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Intensive Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
epinephrine, norepinephrine, vasopressors, septic shock, acute circulatory failure, critically ill patients, 28-day mortality, 90-day mortality, adverse drug reactions, metabolic effects, vasopressor withdrawal, ICU length of stay
MeSH terms
Aged, Blood Pressure, Double-Blind Method, Epinephrine, Female, Humans, Hypotension, Intensive Care Units, Male, Middle Aged, Norepinephrine, Shock, Septic, Vasoconstrictor Agents, Critical Illness, Kaplan-Meier Estimate

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review