Abstract
Purpose
To examine the consequences of administration of norepinephrine on muscle tissue oxygenation in severely hypotensive septic
shock patients.
shock patients.
Methods
This was a prospective observational study conducted in a medical intensive care unit of a university hospital. We included
28 septic shock patients that received early volume resuscitation. All were eligible for receiving norepinephrine because
of life-threatening hypotension and low diastolic arterial pressure. Muscle tissue oxygen saturation (StO2) and its changes during a vascular occlusion test were measured at the level of the thenar eminence using a near-infrared
spectroscopy (NIRS) device. Transpulmonary thermodilution cardiac index (CI) and NIRS-derived variables were obtained before
and after the mean arterial pressure (MAP) was increased by norepinephrine. The baseline StO2 and the vascular occlusion test-derived variables of 17 healthy volunteers were measured and served as controls.
28 septic shock patients that received early volume resuscitation. All were eligible for receiving norepinephrine because
of life-threatening hypotension and low diastolic arterial pressure. Muscle tissue oxygen saturation (StO2) and its changes during a vascular occlusion test were measured at the level of the thenar eminence using a near-infrared
spectroscopy (NIRS) device. Transpulmonary thermodilution cardiac index (CI) and NIRS-derived variables were obtained before
and after the mean arterial pressure (MAP) was increased by norepinephrine. The baseline StO2 and the vascular occlusion test-derived variables of 17 healthy volunteers were measured and served as controls.
Results
In healthy volunteers, StO2 ranged between 75 and 90% and StO2 recovery slopes ranged between 1.5 and 3.4%/s. Administration of norepinephrine, which was associated with an increase in
MAP from 54 ± 8 to 77 ± 9 mmHg (p < 0.05), also induced increases in CI from 3.14 ± 1.03 to 3.61 ± 1.28 L/min/m2 (p < 0.05), in StO2 from 75 ± 9 to 78 ± 9% (p < 0.05) and in StO2 recovery slope from 1.0 ± 0.6 to 1.5 ± 0.7%/s (p < 0.05).
MAP from 54 ± 8 to 77 ± 9 mmHg (p < 0.05), also induced increases in CI from 3.14 ± 1.03 to 3.61 ± 1.28 L/min/m2 (p < 0.05), in StO2 from 75 ± 9 to 78 ± 9% (p < 0.05) and in StO2 recovery slope from 1.0 ± 0.6 to 1.5 ± 0.7%/s (p < 0.05).
Conclusions
Norepinephrine administration aimed at achieving a MAP higher than 65 mmHg in septic shock patients with life-threatening
hypotension resulted in improvement of NIRS variables measured at the level of the thenar eminence.
hypotension resulted in improvement of NIRS variables measured at the level of the thenar eminence.
- Content Type Journal Article
- DOI 10.1007/s00134-010-2013-3
- Authors
- Jean-Francois Georger, Service de reanimation medicale, Centre Hospitalo-Universitaire de Bicetre, Assistance Publique-Hopitaux de Paris, EA 4046, Universite Paris Sud, 78, rue du General Leclerc, 94 270 Le Kremlin-Bicetre, France
- Olfa Hamzaoui, Service de reanimation medicale, Centre Hospitalo-Universitaire de Bicetre, Assistance Publique-Hopitaux de Paris, EA 4046, Universite Paris Sud, 78, rue du General Leclerc, 94 270 Le Kremlin-Bicetre, France
- Anis Chaari, Service de reanimation medicale, Centre Hospitalo-Universitaire de Bicetre, Assistance Publique-Hopitaux de Paris, EA 4046, Universite Paris Sud, 78, rue du General Leclerc, 94 270 Le Kremlin-Bicetre, France
- Julien Maizel, Service de reanimation medicale, Centre Hospitalo-Universitaire de Bicetre, Assistance Publique-Hopitaux de Paris, EA 4046, Universite Paris Sud, 78, rue du General Leclerc, 94 270 Le Kremlin-Bicetre, France
- Christian Richard, Service de reanimation medicale, Centre Hospitalo-Universitaire de Bicetre, Assistance Publique-Hopitaux de Paris, EA 4046, Universite Paris Sud, 78, rue du General Leclerc, 94 270 Le Kremlin-Bicetre, France
- Jean-Louis Teboul, Service de reanimation medicale, Centre Hospitalo-Universitaire de Bicetre, Assistance Publique-Hopitaux de Paris, EA 4046, Universite Paris Sud, 78, rue du General Leclerc, 94 270 Le Kremlin-Bicetre, France
- Journal Intensive Care Medicine
- Online ISSN 1432-1238
- Print ISSN 0342-4642
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