The DOI matches its Crossref record; 15 of the 15 references it cites were found in a registry or an index.
Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study*
Abstract
OBJECTIVE: There is no study that has compared, in a randomized manner, which vasopressor is most suitable in optimizing both systemic and regional hemodynamics in cardiogenic shock patients. Hence, the present study was designed to compare epinephrine and norepinephrine-dobutamine in dopamine-resistant cardiogenic shock. DESIGN: Open, randomized interventional human study. SETTING: Medical intensive care unit in a university hospital. PATIENTS: Thirty patients with a cardiac index of <2.2 L/min/m and a mean arterial pressure of <60 mm Hg resistant to combined dopamine-dobutamine treatment and signs of shock. Patients were not included in cases of cardiogenic shock secondary to acute ischemic events such as myocardial infarction. Noninclusion criteria also included immediate indication of mechanical assistance. INTERVENTIONS: Patients were randomized to receive an infusion of either norepinephrine-dobutamine or epinephrine titrated to obtain a mean arterial pressure of between 65 and 70 mm Hg with a stable or increased cardiac index. MAIN RESULTS: Both regimens increased cardiac index and oxygen-derived parameters in a similar manner. Patients in the norepinephrine-dobutamine group demonstrated heart rates lower (p<.05) than those in the epinephrine group. Epinephrine infusion was associated with new arrhythmias in three patients. When compared to baseline values, after 6 hrs, epinephrine infusion was associated with an increase in lactate level (p<.01), whereas this level decreased in the norepinephrine-dobutamine group. Tonometered PCO2 gap, a surrogate for splanchnic perfusion adequacy, increased in the epinephrine-treated group (p<.01) while decreasing in the norepinephrine group (p<.01). Diuresis increased in both groups but significantly more so in the norepinephrine-dobutamine group, whereas plasma creatinine decreased in both groups. CONCLUSIONS: When considering global hemodynamic effects, epinephrine is as effective as norepinephrine-dobutamine. Nevertheless, epinephrine is associated with a transient lactic acidosis, higher heart rate and arrhythmia, and inadequate gastric mucosa perfusion. Thus, the combination norepinephrine-dobutamine appears to be a more reliable and safer strategy.
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2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
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Comparison of Dopamine and Norepinephrine in the Treatment of Shock
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Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001063 · Cited by 4,922
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Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.12.012 · Cited by 2,862
European Resuscitation Council Guidelines for Resuscitation 2015
Monsieurs, K. G., Nolan, J. P., Bossaert, L. L., Greif, R., Maconochie, I. K., Nikolaou, N. I., Perkins, G. D., Soar, J., Truhlář, A., Wyllie, J., et al. (2015) · Resuscitation · doi:10.1016/j.resuscitation.2015.07.038 · Cited by 915
JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome
Kimura, K., Kimura, T., Ishihara, M., Nakagawa, Y., Nakao, K., Miyauchi, K., Sakamoto, T., Tsujita, K., Hagiwara, N., Miyazaki, S., et al. (2019) · Circulation Journal · doi:10.1253/circj.cj-19-0133 · Cited by 565
Vasopressors for hypotensive shock
Gamper, G., Havel, C., Arrich, J., Losert, H., Pace, N. L., Müllner, M., & Herkner, H. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003709.pub4 · Cited by 239
Metadata
- Authors
- Levy, B., Perez, P., Perny, J., Thivilier, C., & Gerard, A.
- Venue
- Critical Care Medicine
- Published
- 2011-03
- Volume
- 39
- Issue
- 3
- Pages
- 450-455
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2320849083
- Cited by
- 299
- References
- 15
- FWCI
- 5.46
- Type
- journal article
- Language
- en
- Open access
- closed
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- Levy, B., Perez, P., Perny, J., Thivilier, C., & Gerard, A. (2011). Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study*. Critical Care Medicine. https://doi.org/10.1097/ccm.0b013e3181ffe0eb
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