Effect of Higher Mean Arterial Pressure with Norepinephrine on Tissue Oxygenation
and Perfusion in Patients of Septic Shock
Copyright © 2012 SciRes. IJCM
410
culation, urine output or splanchnic perfusion. However
the APACHE II score in his group of patients was 29 ±
2.1 which was more than in the study group of Aurelie
bourgoin et al. [2] which was 27 - 28 in this study. In
both studies the patient population belonged to a higher
severity-of-illness score compared to our study which
had a mean SOFA score of 7.7. Also the equilibration
period in this study was only 60 minutes which was
probably not sufficient to reflect changes in tissue oxy-
genation and perfusion parameters.
In the above mentioned studies the patients enrolled
were older, in mid sixties compared to our patients, with
mean age of 44 yr. Our results are applicable to younger
population with recent onset of septic shock (67.5% pa-
tients with onset within 2 days) and primarily abdominal
(65%) source of sepsis. This can be seen in Figure 1
which shows that as the duration of septic shock in-
creases, the rise in PtcO2 decreases with increase in MAP.
5. Conclusion
Higher MAP with norepinephrine is associated with im-
proved perfusion and oxygenation parameters in younger
age group with septic shock when NE therapy is insti-
tuted early in the course of disease. Further research is
required to know more about long term effects of higher
arterial pressure targets in these patients.
REFERENCES
[1] ACCP/SCCM, “Definitions of Sepsis and Organ Failure
and Guidelines for the Use of Innovative Therapies in
Sepsis,” Critical Care Medicine, Vol. 20, 1992, pp. 864-
874. doi:10.1097/00003246-199206000-00025
[2] A. Bourgoin, M. Leone, A. Delmas, F. Garnice, J. Al-
banese and C. Martin, “Effect of Increasing MAP in Pa-
tient with Septic Shock: Effect on Oxygen Variables and
Renal Functions. Critical Care Medicine, Vol. 33, 2005,
pp. 780-786. doi:10.1097/01.CCM.0000157788.20591.23
[3] S. Jhanji, S. Stirling, N. Patel, C. Hinds and R. Pearse,
“The Effect of Increasing Doses of Norepinephrine on
Tissue Oxygenation and Microvascular Flow in Patients
with Septic Shock,” Critical Care Medicine, Vol. 37, No.
6, 2009, pp. 1961-1966.
doi:10.1097/CCM.0b013e3181a00a1c
[4] K. G. Barry, R. I. Mazze and F. D. Schwartz, “Prevention
of Surgical Oligouria Renal Hemodynamic Suppression
by Sustained Hydration,” New England Journal of Medi-
cine, Vol. 270, No. 26, 1964, pp. 1371-1377.
[5] C. Martin, L. Papazian, G. Perrin, et al., “Norepinephrine
or Dopamine for Treatment of Hyperdynamic Septic
Shock?” Chest, Vol. 103, No. 6, 1993, pp. 1826-1831.
[6] D. Ledoux, M. E. Astiz, C. M. Carpati and E. Rackow,
“Effects of Perfusion Pressure on Tissue Perfusion in
Septic Shock,” Critical Care Medicine, Vol. 28, No. 8,
2000, pp. 2729-2732.
doi:10.1097/00003246-200008000-00007
[7] T. Venzi, J. Romand, D. Bergener, M. Svensson, P. M.
Suter and A. Aneman, “Norepinephrine Induced Blood
Pressure Increase to Pre-Shock Level Worsens Regional
Flow Distribution in Porcine Septic Shock Model,”
Critical Care, Vol. 4, No. S1, 2000, p. 48.
doi:10.1186/cc768
[8] A. Dublin, M. Pozo, C. A. Casabella, F. Palizas, G.
Murias, C. Ince, et al., “Increasing Arterial Blood Pres-
sure with Norepinephrine Does Not Improve Microcircu-
latory Blood Flow: A Prospective Study,” Critical Care,
Vol. 13, No. 3, 2009, pp. 1-8.
[9] M. Yu, S. Y. Morita, S. R. Daniel, et al., “Transcutaneous
Pressure of O2 A Noninvasive and Early Detector of Pe-
ripheral Shock and Outcome,” SHOCK, Vol. 26, 2006,
450-456. doi:10.1097/01.shk.0000228798.18174.6a
[10] R. S. Irwin and J. M. Rippe’s, “Intensive Care Med,” 6th
Edition, Lippincott William & Wilkin, Vol. 12, 2008, pp.
249-250.
[11] R. P. Dellinger, “Cardiovascular Management of Septic
Shock,” Critical Care Medicine, Vol. 31, No. 3, 2003, pp.
946-953.
[12] R. Bellomo and D. Giantomasso, “Noradrenaline and the
Kidney: Friends or Foes?” Critical Care, Vol. 5, No. 6,
2001, pp. 294-298.
[13] S. Deruddre, G. Cheisson, J. Mazoit, E. Vicout, D. Ben-
hamou and J, Duranteau, “Renal Arterial Resistance in
Septic Shock—Effect of Increasing MAP with Norepi-
nephine on Renal Resistive Index with Droppler Ultra-
sound,” Intensive Care Medicine, Vol. 33, No. 9, 2007,
pp. 1557-1562.