Home Current Issue Previous Issues Published Ahead-of-Print Podcasts For Authors Journal Info
Skip Navigation LinksHome > March 2011 - Volume 39 - Issue 3 > Comparison of norepinephrine-dobutamine to epinephrine for h...
Critical Care Medicine:
doi: 10.1097/CCM.0b013e3181ffe0eb
Feature Articles

Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study*

Levy, Bruno MD, PhD; Perez, Pierre MD; Perny, Jessica MD; Thivilier, Carine MD; Gerard, Alain MD

Collapse Box

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−1/m−2 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.

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.