• Crit Care · Jan 2008

    Randomized Controlled Trial Comparative Study

    Phenylephrine versus norepinephrine for initial hemodynamic support of patients with septic shock: a randomized, controlled trial.

    • Andrea Morelli, Christian Ertmer, Sebastian Rehberg, Matthias Lange, Alessandra Orecchioni, Amalia Laderchi, Alessandra Bachetoni, Mariadomenica D'Alessandro, Hugo Van Aken, Paolo Pietropaoli, and Martin Westphal.
    • Department of Anesthesiology and Intensive Care, University of Rome, La Sapienza, Viale del Policlinico 155, Rome 00161, Italy. andrea.morelli@uniroma1.it
    • Crit Care. 2008 Jan 1;12(6):R143.

    IntroductionPrevious findings suggest that a delayed administration of phenylephrine replacing norepinephrine in septic shock patients causes a more pronounced hepatosplanchnic vasoconstriction as compared with norepinephrine. Nevertheless, a direct comparison between the two study drugs has not yet been performed. The aim of the present study was, therefore, to investigate the effects of a first-line therapy with either phenylephrine or norepinephrine on systemic and regional hemodynamics in patients with septic shock.MethodsWe performed a prospective, randomized, controlled trial in a multidisciplinary intensive care unit in a university hospital. We enrolled septic shock patients (n = 32) with a mean arterial pressure below 65 mmHg despite adequate volume resuscitation. Patients were randomly allocated to treatment with either norepinephrine or phenylephrine infusion (n = 16 each) titrated to achieve a mean arterial pressure between 65 and 75 mmHg. Data from right heart catheterization, a thermodye dilution catheter, gastric tonometry, acid-base homeostasis, as well as creatinine clearance and cardiac troponin were obtained at baseline and after 12 hours. Differences within and between groups were analyzed using a two-way analysis of variance for repeated measurements with group and time as factors. Time-independent variables were compared with one-way analysis of variance.ResultsNo differences were found in any of the investigated parameters.ConclusionsThe present study suggests there are no differences in terms of cardiopulmonary performance, global oxygen transport, and regional hemodynamics when phenylephrine was administered instead of norepinephrine in the initial hemodynamic support of septic shock.Trial RegistrationClinicalTrial.gov NCT00639015.

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