Impact of norepinephrine on right ventricular afterload and function in septic shock-a strain echocardiography study

Acta Anaesthesiologica Scandinavica
Keti DallaSven-Erik Ricksten

Abstract

In this observational study, the effects of norepinephrine-induced changes in mean arterial pressure (MAP) on right ventricular (RV) systolic function, afterload and pulmonary haemodynamics were studied in septic shock patients. We hypothesised that RV systolic function improves at higher doses of norepinephrine/MAP levels. Eleven patients with septic shock requiring norepinephrine after fluid resuscitation were included <24 hours after ICU arrival. Study enrolment and insertion of a pulmonary artery catheter was performed after written informed consent from the next of kin. Norepinephrine infusion was titrated to target mean arterial pressures (MAP) of 60, 75 and 90 mmHg in a random sequential order. At each target MAP, strain-and conventional echocardiographic-and pulmonary haemodynamic variables were measured. RV afterload was assessed as effective pulmonary arterial elastance, (Epa ) and pulmonary vascular resistance index, (PVRI). RV free wall peak strain was the primary end-point. At highest compared to lowest norepinephrine dose/MAP level, RV free wall peak strain increased from -19% to -25% (32%, P = .003), accompanied by increased tricuspid annular plane systolic excursion (22%, P = .01). At the highest norepinephrine ...Continue Reading

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Citations

Oct 27, 2020·The International Journal of Cardiovascular Imaging·D BeitzkeC Loewe
Jan 9, 2020·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Rohan MagoonSurendra K Jangid

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