Comparison Between Norepinephrine Alone Versus Norepinephrine/Vasopressin Combination for Resuscitation in Septic Shock
Abstract Introduction Septic shock is one of the leading causes of death in the intensive care unit (ICU) through its consequences on vital organ function. Combinations of vasopressors for effective cardiovascular support play an essential role in septic shock. This study aimed to compare the effect...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Springer
2021-05-01
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| Series: | Egyptian Journal of Critical Care Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1097/EJ9.0000000000000020 |
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| Summary: | Abstract Introduction Septic shock is one of the leading causes of death in the intensive care unit (ICU) through its consequences on vital organ function. Combinations of vasopressors for effective cardiovascular support play an essential role in septic shock. This study aimed to compare the effect of norepinephrine (NE) alone versus early NE/vasopressin (VP) combination on tissue perfusion and renal function in septic shock patients. Materials and methods The study enrolled 90 adult ICU patients who developed septic shock. They were randomly divided into two equal groups; NE group (received NE infusion) and VP/NE group (received NE and VP infusion). All patients received standard therapy for septic shock and standard of care in the ICU. Both groups were compared as regard serum lactate level as a primary outcome, central venous oxygen saturation, heart rate, mean arterial blood pressure, sepsis biomarkers (C-reactive protein and white blood cell count), renal biomarkers (urea, creatinine, and urinary neutrophil gelatinase associated Lipocalin), time of recovery from septic shock, NE dose, the need for mechanical ventilation and renal replacement therapy, length of ICU stay and 28 days mortality as secondary outcomes. Results We found that the serum lactate, heart rate, NE dose at 6 and 48 hours, length of ICU stay, renal biomarkers and the need for renal replacement therapy were significantly lower, but the mean arterial blood pressure were significantly higher in the VP/NE group compared to the NE group. Thirty-nine (86.7%) patients in the NE group continued with the studied drugs combination after 48 hours versus 22 (48.9%) in NE/VP group (P<.001). There was no significant difference between both groups regarding central venous oxygen saturation, sepsis biomarkers, the need for mechanical ventilation or the incidence of 28days of mortality. Discussion Early combination of VP with NE in septic shock induced a significant improvement of serum lactate, renal function, and decreased NE infusion with significant earlier recovery before 48 hours from septic shock. Trial registration This study was registered at ClinicalTrials.gov (NCT04302584). |
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| ISSN: | 2090-7303 2090-9209 |