OBJECTIVE: Septic shock is a state of extreme physiologic stress associated with a wide array of hemodynamic, metabolic and physiologic processes attempting to restore homeostasis Clinical guidelines recommend norepinephrine as initial vasopressor of choice for septic shock, with dopamine suggested as an alternative vasopressor in selected patients with low risk of tachyarrhythmias and absolute or relative bradycardia. Patients with septic shock treated during shortage of norepinephrine, the recommended first line, were more likely to die and based on this critical issue we aim in this study to evaluate the clinical effectiveness of ino-constrictor dose of dopamine as an alternative vasopressor during norepinephrine shortage regarding the percentage changes in mean arterial pressure (% ∆MAP), risk of tachyarrhythmia, ICU length of stay (LOS) and 28-day ICU mortality. MATERIALS and METHODS: A retrospective analysis will be conducted in our adult ICU at King Hussein Medical Hospital (KHMH) for patients who were admitted via the emergency department (ED) or via other hospital wards between April 2018 and April 2020 and who were their baseline demographics, diagnostics, anthropometrics, hemodynamics, fluids and vasopressors can be obtained or assessed from our institutional electronic health record (Hakeem). Patients will be excluded if they discharged or died before completed at least 1 week of ICU admission. A chi square test will be conducted to evaluate the proportion of studied patients in both tested vasopressors who had HR >120 bpm and overall, 28-day ICU mortality. An independent T-test will be conducted to compare the Mean±SD and Mean difference±SEM of %∆MAP and ICU LOS between the two tested vasopressor groups. RESULTS: Dopamine associated with significant increases in the Means±SDs of: SBPavg (101.87±10.00mmHg vs. 94.33±9.17mmHg); DBPavg (60.12±7.32mmHg vs. 55.67±7.01 mmHg); and MAPavg (71.31±11.69mmHg vs. 66.53±10.84 mmHg). And a significant reduction in HRavg (95.13±8.7bpm vs. 107.31±9.35bpm); SIavg (1.39±0.38 bpm/mmHg vs. 1.68±0.47 bpm/mmHg); and mSIavg (1.39±0.38 bpm/mmHg vs. 1.68±0.47 bpm/mmHg) compared to Norepinephrine. CONCLUSION: Dopamine is associated higher mortality and a higher incidence tachyarrythmia compared to norepinephrine.
Septic shock is a life-threatening fetal condition associated with low blood pressure, metabolic, cellular and circulatory abnormalities which lead to increased risk of mortality [1] persistent hypotension regardless of fluid resuscitation necessitate vasopressor use. Clinical guidelines recommend norepinephrine as first line vasopressor in septic shock patients who not response to volume resuscitation to restore mean arterial pressure MAP (>=65 mmHg) [2,3], failure of fluid resuscitation occurs when approximately >=4L of crystalloid solution to maintain MAP >=65mmHg or if evidence of volume overload is present [4].
Norepinephrine is safer and more effective than dopamine in restoring MAP in septic shock patients[2,5,6], norepinephrine has higher affinity to α-adrenergic receptors than β-adrenergic receptors that leads to significant increase in MAP and little changes in heart rate and cardiac output ,while dopamine has higher affinity to β-adrenergic receptors than α-adrenergic receptors so that it is precipitate tachyarrhythmias; its merely an alternative to norepinephrine in patients with low risk of tachyarrhythmias and relative bradycardia[6,7,8].
In this study we will evaluate the clinical effectiveness of ino-constrictor dose of dopamine as an alternative vasopressor during norepinephrine shortage regarding the percentage changes in mean arterial pressure (% ∆MAP), risk of tachyarrhythmia, ICU length of stay (LOS) and 28-day ICU mortality.
This was an observational retrospective study, conducted in King Hussein Medical Center (KHMH) at Royal Medical Services (RMS) in Jordan. Our study was approved by our institutional Review Board (IRB). The study done on 188 critically ill patients with septic shock, selection and collection criteria explained on Figure 1.
We used independent t-test to compare the Mean±SD and Mean difference±SEM of %∆MAP and ICU LOS between the two tested vasopressor groups; group I patients on norepinephrine and group II patients on ino-constructor dose of dopamine. A chi-square test conducted to evaluate the proportion of studied patients in both tested vasopressors who had HR >120 bpm and overall, 28-day ICU mortality. Statistical analysis was performed using IBM SPSS ver. 25 (IBM Corp., Armonk, NY, USA) and p-values ≤0.05 were considered statistically significant.
The mean age of our 188 studied critically ill patients was 58.94±10.37 years 131 patients (69.7%) were male and 57 patients (30.3%) were female. The overall 28-day ICU mortality was 40.4% (76 patients) in overall studied cohort, 41.9% (36 participants) in Group I and 39.2% (40 participants). The ICU and overall hospital LOS were 12.76±4.95 days and 17.07±6.98 days with an insignificant Mean difference±SEM of -0.02±0.73 days and -0.05±1.03 days, respectively. The Mean±SD of body weight (BW), body mass index (BMI),total fluid input, vasopressor infusion rate, corrected calcium systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), corrected calcium (cCa+2), magnesium level (Mg+2), potassium level (K+), maximum, minimum and average blood glucose levels (BGmin, BGmax and BGavg) and total insulin dose were insignificant different between the two groups.
The Means±SDs of SBPmax, %∆SBPmax, SBPmin, %∆SBPmin, SBPavg,%∆SBPavg, DBPmax %∆DBPmax, DBPmin, %∆DBPmin, DBPavg, %∆DBPavg, MAPmax, %∆MAPmax, MAPmin, %∆MAPmin, MAPavg and %∆MAPavg were significantly higher in septic critically ill patients who received DOP (Group I) than in septic critically patients who received NE (Group II) (109.67±10.98 mmHg vs 101.19±10.03 mmHg), (25.24%±2.38% vs 15.23%±2.54%), (96.69±8.61 mmHg vs 90.21±7.88 mmHg), (43.68%±3.22% vs 33.64%±3.54%), (101.87±10.00 mmHg vs 94.33±9.17 mmHg), (34.58%±3.38% vs 24.33%±3.71%), (67.27±6.12 mmHg vs 62.23±5.68 mmHg), (33.08%±3.69% vs23.03%±4.07%), (58.88±6.71 mmHg vs 62.23±5.68 mmHg), (52.63%±4.21% vs 42.54%±4.93%), (60.12±7.32 mmHg vs 55.67±7.01 mmHg), (36.54%±7.14% vs 26.34%±8.21%), (85.44±9.66 mmHg vs 79.69±8.84 mmHg), (43.59%±3.33% vs 33.57%±3.56%), (63.97±12.62 mmHg vs 60.34±11.62 mmHg), (61.92%±4.50% vs 51.92%±4.79%), (71.31±11.69 mmHg vs 66.53±10.84 mmHg) and (39.55%±7.38% vs 29.91%±7.77%) with significant Mean differences±SEMs of +8.49±1.53 mmHg, +10.02%±0.36%, +6.48±1.20 mmHg, +10.04%±0.49%, +7.54±1.39 mmHg, +10.25%±0.52%, +5.04±0.86 mmHg, +10.05%±0.57%, +3.85±0.94 mmHg, +10.09%±0.68%, +4.45±1.05 mmHg, +10.21%±1.13%, +5.75±1.35 mmHg, +10.02%±0.51%, 3.62±1.77 mmHg, 9.99%±0.68%, 4.78±1.65 mmHg and 9.63%±1.11%, respectively.
Table 1: Demographics, anthropometrics, nutritional indices and other comparison lab parameters of our studied septic patients
| Variable | Total (N=188) | Group I (N=86) DOP Mean±SD | Group II NE (N=102) Mean±SD | Group I vs Group II Mean difference±SEM | p-Value | ||||
Age (Yrs) | 58.94±10.37 | 58.8310.31 | 59.04±10.47 | -0.21±1.52 | 0.889 (NS) | ||||
Gender | Female | 57 (30.3%) | 25 (29.1%) | 32 (31.4%) | - | 0.428 (NS) | |||
Male | 131 (69.7%) | 61 (70.9%) | 70 (68.6%) | ||||||
BW (Kg) | 74.05±10.23 | 73.34±9.69 | 74.65±10.68 | -1.31±1.49 | 0.383 (NS) | ||||
BMI (Kg/m2) | 25.90±3.97 | 25.57±3.68 | 26.18±4.20 | -0.61±0.58 | 0.294 (NS) | ||||
∑Fluid Input (ml/day) | 2709±422 | 2704±393 | 2714±446 | -10.0±61.9 | 0.872 (NS) | ||||
Vasopressor Rate (ml/hr) | 6.73±6.39 | 12.46±2.23 | 12.41±2.09 | 0.05±0.32 | 0.873 (NS) | ||||
NE rate (mcg/min) | 12.43±2.15 | 0.00±0.00 | 12.41±2.09 | -12.41±0.23 | 0.000 (S) | ||||
DOP rate (mcg/kg/min) | 5.69±6.40 | 12.46±2.23 | 0.00±0.00 | 12.46±0.22 | 0.000 (S) | ||||
cCa+2 (mg/dl) | 8.05±0.29 | 8.07±0.22 | 8.02±0.33 | 0.05±0.04 | 0.216 (NS) | ||||
Mg+2 (mg/dl) | 1.26±0.06 | 1.25±0.04 | 1.26±0.07 | -0.009±0.01 | 0.252 (NS) | ||||
BGmin (mg/dl) | 140.8±15.18 | 141.7±15.30 | 140.1±15.12 | 1.54±2.23 | 0.491 (NS) | ||||
BGmax (mg/dl) | 236.7±21.66 | 235.8±19.73 | 237.3±23.23 | -1.52±3.18 | 0.633 (NS) | ||||
BGavg (mg/dl) | 188.7±6.72 | 188.8±5.72 | 188.7±7.48 | 0.03±0.99 | 0.975 (NS) | ||||
∑ Insulin dose (IU/day) | 99.88±48.19 | 99.4±46.0 | 100.3±50.18 | -0.89±7.07 | 0.899 (NS) | ||||
%BGvar | 50.51%±16.7% | 49.7%±16.53% | 51.2%±16.97% | -1.49%±2.5% | 0.545 (NS) | ||||
K+ (mEq/l) | 2.84±0.19 | 2.84±0.18 | 2.85±0.20 | -0.01±0.03 | 0.841 (NS) | ||||
Pre-ICU LOS (day) | 4.32±3.95 | 4.30±3.68 | 4.33±4.18 | -0.03±0.58 | 0.957 (NS) | ||||
ICU LOS (day) | 12.76±4.95 | 12.74±4.92 | 12.76±5.00 | -0.02±0.73 | 0.977 (NS) | ||||
Hospital LOS (day) | 17.07±6.98 | 17.05±6.99 | 17.10±7.00 | -0.05±1.03 | 0.960 (NS) | ||||
Overall, 28-day ICU Survival | 112 (59.6%) | 50 (58.1%) | 62 (60.8%) | - | 0.413 (NS) | ||||
Overall, 28-day ICU Mortality | 76 (40.4%) | 36 (41.9%) | 40 (39.2%) | ||||||
Data were presented as either Mean±SD and Mean difference±SEM by using One sample T-test and Independent T-test or as Number (Percentage) by using Chi square test. Group I: Septic mechanically ventilated critically ill patients who were on DOP vasopressors. Group II: Septic mechanically ventilated critically ill patients who were on NE vasopressors. | |||||||||
Yrs: Years S: Significant (p≤005) NS: Non-Significant (p>005) IU: International unit LOS: Length of stay | BW: Body weight BMI: Body mass index Mg: Magnesium level
| BG: Blood glucose level ICU: Intensive care unit cCa: Corrected calcium level | Min: Minimum Max: Maximum Avg: Average K" Potassium
| ||||||
Table 2: Comparison baseline and follow-up hemodynamics of blood pressures in our studied septic patients
| Variable | Total (N=188) | Group I (N=86) DOP Mean±SD | Group II NE (N=102) Mean±SD | Group I vs Group II Mean difference±SEM | p-Value | |||
SBPmax0 (mmHg) | 87.68±8.04 | 87.55±8.15 | 87.78±7.99 | -0.24±1.18 | 0.840 (NS) | |||
SBPmax1 (mmHg) | 105.07±11.27 | 109.67±10.98 | 101.19±10.03 | 8.49±1.53 | 0.000 (S) | |||
%∆SBPmax01 | 19.81%±5.57% | 25.24%±2.38% | 15.23%±2.54% | 10.02%±0.36% | 0.000 (S) | |||
SBPmin0 (mmHg) | 67.38±5.09 | 67.33±5.23 | 67.42±4.99 | -0.09±0.75 | 0.898 (NS) | |||
SBPmin1 (mmHg) | 93.17±8.81 | 96.69±8.61 | 90.21±7.88 | 6.48±1.20 | 0.000 (S) | |||
%∆SBPmin01 | 38.23%±6.05% | 43.68%±3.22% | 33.64%±3.54% | 10.04%±0.49% | 0.000 (S) | |||
SBPavg0 (mmHg) | 75.71±6.49 | 75.60±6.61 | 75.80±6.42 | -0.19±0.95 | 0.834 (NS) | |||
SBPavg1 (mmHg) | 97.78±10.25 | 101.87±10.00 | 94.33±9.17 | 7.54±1.39 | 0.000 (S) | |||
%∆SBPavg01 | 29.02%±6.23% | 34.58%±3.38% | 24.33%±3.71% | 10.25%±0.52% | 0.000 (S) | |||
%SBPvar0 | 26.65%±2.47% | 26.58%±2.39% | 26.71%±2.53% | -0.13%±0.36% | 0.720 (NS) | |||
%SBPvar1 | 12.03%±2.83% | 12.55%±2.65% | 11.59%±2.91% | 0.95%±0.41% | 0.021 (NS) | |||
DPBmax0 (mmHg) | 50.51±3.70 | 50.44±3.76 | 50.57±3.67 | -0.13±0.54 | 0.816 (NS) | |||
DPBmax1 (mmHg) | 64.53±6.39 | 67.27±6.12 | 62.23±5.68 | 5.04±0.86 | 0.000 (S) | |||
%∆DBPmax01 | 27.63%±6.35% | 33.08%±3.69% | 23.03%±4.07% | 10.05%±0.57% | 0.000 (S) | |||
DBPmin0 (mmHg) | 38.52±3.59 | 38.50±3.72 | 38.54±3.51 | -0.04±0.53 | 0.941 (NS) | |||
DBPmin1 (mmHg) | 56.79±6.69 | 58.88±6.71 | 55.03±6.18 | 3.85±0.94 | 0.000 (S) | |||
%∆DBPmin01 | 47.16%±6.82% | 52.63%±4.21% | 42.54%±4.93% | 10.09%±0.68% | 0.000 (S) | |||
DBPavg0 (mmHg) | 43.92±3.71 | 43.91±3.82 | 43.93±3.63 | -0.02±0.54 | 0.964 (NS) | |||
DBPavg1 (mmHg) | 57.70±7.47 | 60.12±7.32 | 55.67±7.01 | 4.45±1.05 | 0.000 (S) | |||
%∆DBPavg01 | 31.01%±9.25% | 36.54%±7.14% | 26.34%±8.21% | 10.21%±1.13% | 0.000 (S) | |||
%DBPvar0 | 27.52%±3.46% | 27.46%±3.41% | 27.57%±3.51% | -0.12%±0.51% | 0.821 (NS) | |||
%DBPvar1 | 13.87%±4.49% | 14.30%±3.91% | 13.51%±4.93% | 0.79%±0.66% | 0.228 (NS) | |||
MAPmax0 (mmHg) | 59.56±6.04 | 59.44±6.17 | 59.67±5.96 | -0.22±0.89 | 0.800 (NS) | |||
MAPmax1 (mmHg) | 82.32±9.64 | 85.44±9.66 | 79.69±8.84 | 5.75±1.35 | 0.000 (S) | |||
%∆MAPmax01 | 38.16%±6.08% | 43.59%±3.33% | 33.57%±3.56% | 10.02%±0.51% | 0.000 (S) | |||
MAPmin0 (mmHg) | 39.51±7.08 | 39.41±7.15 | 39.59±7.05 | -0.19±1.04 | 0.854 (NS) | |||
MAPmin1 (mmHg) | 62.00±12.19 | 63.97±12.62 | 60.34±11.62 | 3.62±1.77 | 0.042 (S) | |||
%∆MAPmin01 | 56.49%±6.82% | 61.92%±4.50% | 51.92%±4.79% | 9.99%±0.68% | 0.000 (S) | |||
MAPavg0 (mmHg) | 51.001±6.28 | 50.93±6.37 | 51.07±6.23 | -0.14±0.92 | 0.881 (NS) | |||
MAPavg1 (mmHg) | 68.72±11.46 | 71.31±11.69 | 66.53±10.84 | 4.78±1.65 | 0.004 (S) | |||
%∆MAPavg01 | 34.32%±8.97% | 39.55%±7.38% | 29.91%±7.77% | 9.63%±1.11% | 0.000 (S) | |||
%MAPvar0 | 40.09%±6.92% | 40.18%±7.06% | 40.01%±6.83% | 0.16%±1.02% | 0.874 (NS) | |||
%MAPvar1 | 30.97%±9.07% | 31.49%±9.12% | 30.54%±9.04% | 0.95%±1.33% | 0.475 (NS) | |||
Data were presented as either Mean±SD and Mean difference±SEM by using One sample T-test and Independent T-test or as Number (Percentage) by using Chi square test. Group I: Septic mechanically ventilated critically ill patients who were on DOP vasopressors. Group II: Septic mechanically ventilated critically ill patients who were on NE vasopressors. | ||||||||
SBP: Systolic blood pressure DBP: Diagnostic blood pressure MAP: Mean arterial pressure | 0: Baseline before vasopressors 1: After vasopressors | Max: Maximum Min: Minimum
| %∆: Percentage changes Avg: Average Var: Variation | |||||
In contrast, the Means±SDs of HRmax, %∆HRmax, HRmin, %∆HRmin, HRavg, %∆HRavg, SImax, %∆SImax, SImin, %∆SImin, SIavg, %∆SIavg, mSImax, %∆mSImax, mSImin, %∆mSImin, mSIavg and %∆mSIavg were significantly higher in septic critically patients who were administered NE (Group II) than in septic critically ill patients who were administered DOP (Group I) (114.37±10.39 bpm vs 100.72±9.47 bpm), (-6.47%±1.69% vs -17.95%±1.55%), (91.86±6.32 bpm vs 81.47±5.88 bpm), (-1.40%±1.71% vs -12.87%±1.57%), (107.31±9.35 bpm vs 95.13±8.7 bpm), (-0.44%±3.35% vs -11.96%±3.09%), (1.29±0.23 bpm/mmHg vs 1.06±0.19 bpm/mmHg), (-14.44%±7.29% vs -29.99%±5.92%), (0.92±0.16 bpm/mmHg vs 0.76±0.13 bpm/mmHg), (-35.99%±7.29% vs -47.73%±5.98%), (1.16±0.22 bpm/mmHg vs 0.95±0.19 bpm/mmHg), (-7.46%±10.07% vs -24.14%±8.22%), (1.99±0.56 bpm/mmHg vs 1.66±0.48 bpm/mmHg), (-15.72%±14.92% vs -30.17%±12.49%), (1.18±0.22 bpm/mmHg vs 0.97±0.19 bpm/mmHg), (-18.51%±10.21% vs -32.71%±8.53%), (1.68±0.47 bpm/mmHg vs 1.39±0.38 bpm/mmHg) and (-9.47%±16.13% vs -25.15%±13.21%) with significant Mean differences±SEMs of -13.65±1.46 bpm, -11.48%±0.24%, -10.39±0.89 bpm, -11.47%±0.24%, -12.19±1.33 bpm, -11.52%±0.47%, -0.23±0.03 bpm/mmHg, -15.56%±0.98%, -0.17±0.02 bpm/mmHg, -11.74%±0.99%, -0.21±0.03 bpm/mmHg, -16.69%±1.36%, -0.34±0.08 bpm/mmHg, -14.44%±2.03%, -0.20±0.03 bpm/mmHg, -14.20%±1.39%, -0.29±0.06 bpm/mmHg and -15.69%±2.18%.
Demographics, anthropometrics, haemodynamic and lab parameters of the study’s septic mechanically ventilated critically ill patients are summarised in Tables 1-3.
Table 3: Comparison baseline and follow-up hemodynamics of HRs and shock indices in our studied septic patients.
| Variable | Total (N=188) | Group I (N=86) DOP Mean±SD | Group II NE (N=102) Mean±SD | Group I vs Group II Mean difference±SEM | p-Value | ||
HRmax0 (bpm) | 122.45±11.07 | 122.71±11.34 | 122.23±10.89 | 0.48±1.63 | 0.766 (NS) | ||
HRmax1 (bpm) | 108.13±12.07 | 100.72±9.47 | 114.37±10.39 | -13.65±1.46 | 0.000 (S) | ||
%∆HRmax01 | -11.72%±5.96% | -17.95%±1.55% | -6.47%±1.69% | -11.48%±0.24% | 0.000 (S) | ||
HRmin0 (bpm) | 93.28±6.24 | 93.42±6.38 | 93.16±6.16 | 0.26±0.92 | 0.775 (NS) | ||
HRmin1 (bpm) | 87.11±8.02 | 81.47±5.88 | 91.86±6.32 | -10.39±0.89 | 0.000 (S) | ||
%∆HRmin01 | -6.65%±5.96% | -12.87%±1.57% | -1.40%±1.71% | -11.47%±0.24% | 0.000 (S) | ||
HRavg0 (bpm) | 107.9±8.54 | 108.0±8.72 | 107.7±8.42 | 0.26±1.25 | 0.833 (NS) | ||
HRavg1 (bpm) | 101.74±10.89 | 95.13±8.7 | 107.31±9.35 | -12.19±1.33 | 0.000 (S) | ||
%∆HRavg01 | -5.71%±6.59% | -11.96%±3.09% | -0.44%±3.35% | -11.52%±0.47% | 0.000 (S) | ||
%HRvar0 | 26.83%±2.62% | 26.86%±2.68% | 26.81%±2.58% | 0.05%±0.38% | 0.889 (NS) | ||
%HRvar1 | 20.45%±2.49% | 20.05%±2.49% | 20.78%±2.45% | -0.73%±0.36% | 0.045 (S) | ||
SImax0 (bpm/mmHg) | 1.49±0.15 | 1.49±0.15 | 1.49±0.15 | 0.003±0.02 | 0.868 (NS) | ||
SImax1 (bpm/mmHg) | 1.18±0.25 | 1.06±0.19 | 1.29±0.23 | -0.23±0.03 | 0.000 (S) | ||
%∆SImax01 | -21.55%±10.25% | -29.99%±5.92% | -14.44%±7.29% | -15.56%±0.98% | 0.000 (S) | ||
SImin0 (bpm/mmHg) | 1.01±0.06 | 1.01±0.07 | 1.01±0.06 | 0.002±0.01 | 0.850 (NS) | ||
SImin1 (bpm/mmHg) | 0.85±0.17 | 0.76±0.13 | 0.92±0.16 | -0.17±0.02 | 0.000 (S) | ||
%∆SImin01 | -41.36%±8.91% | -47.73%±5.98% | -35.99%±7.29% | -11.74%±0.99% | 0.000 (S) | ||
SIavg0 (bpm/mmHg) | 1.24±0.10 | 1.24±0.11 | 1.24±0.10 | 0.002±0.02 | 0.907 (NS) | ||
SIavg1 (bpm/mmHg) | 1.06±0.23 | 0.95±0.19 | 1.16±0.22 | -0.21±0.03 | 0.000 (S) | ||
%∆SIavg01 | -15.09%±12.45% | -24.14%±8.22% | -7.46%±10.07% | -16.69%±1.36% | 0.000 (S) | ||
SIvar0 (bpm/mmHg) | 38.82%±4.14% | 38.86%±4.28% | 38.79%±4.03% | 0.06%±0.61% | 0.915 (NS) | ||
SIvar1 (bpm/mmHg) | 31.44%±1.82% | 31.55%±1.88% | 31.35%±1.77% | 0.20%±0.27% | 0.448 (NS) | ||
mSImax0 (bpm/mmHg) | 2.33±0.27 | 2.34±0.28 | 2.33±0.26 | 0.006±0.04 | 0.884 (NS) | ||
mSImax1 (bpm/mmHg) | 1.84±0.55 | 1.66±0.48 | 1.99±0.56 | -0.34±0.08 | 0.000 (S) | ||
%∆mSImax01 | -22.33%±15.59% | -30.17%±12.49% | -15.72%±14.92% | -14.44%±2.03% | 0.000 (S) | ||
mSImin0 (bpm/mmHg) | 1.44±0.09 | 1.44±0.10 | 1.43±0.09 | 0.002±0.01 | 0.892 (NS) | ||
mSImin1 (bpm/mmHg) | 1.08±0.23 | 0.97±0.19 | 1.18±0.22 | -0.20±0.03 | 0.000 (S) | ||
%∆mSImin01 | -25.01%±11.82% | -32.71%±8.53% | -18.51%±10.21% | -14.20%±1.39% | 0.000 (S) | ||
mSIavg0 (bpm/mmHg) | 1.83±0.17 | 1.84±0.17 | 1.83±0.17 | 0.003±0.02 | 0.912 (NS) | ||
mSIavg1 (bpm/mmHg) | 1.55±0.45 | 1.39±0.38 | 1.68±0.47 | -0.29±0.06 | 0.000 (S) | ||
%∆mSIavg01 | -16.64%±16.77% | -25.15%±13.21% | -9.47%±16.13% | -15.69%±2.18% | 0.000 (S) | ||
mSIvar0 (bpm/mmHg) | 48.64%±5.70% | 48.69%±5.89% | 48.59%±5.56% | 0.09%±0.84% | 0.909 (NS) | ||
mSIvar1 (bpm/mmHg) | 47.25%±10.15% | 47.47%±10.30% | 47.07%±10.07% | 0.40%±1.49% | 0.788 (NS) | ||
Data were presented as either Mean±SD and Mean difference±SEM by using One sample T-test and Independent T-test or as Number (Percentage) by using Chi square test. Group I: Septic mechanically ventilated critically ill patients who were on DOP vasopressors. Group II: Septic mechanically ventilated critically ill patients who were on NE vasopressors. | |||||||
HR: Heart rate SI: Shock index (HR/SBP) mSI: Modified shock index (HR/MAP) | 0: Baseline before vasopressors 1: After vasopressors %∆: Percentage changes | Max: Maximum Min: Minimum Avg: Average Var: Variation | |||||
This study was conducted as retrospective to evaluate the clinical efficacy of dopamine as alternative therapy during Norepinephrine shortages compared with Norepinephrine as vasopressors in mechanically ventilated septic shock patients.
Dopamine is a β1-adrenergic agonist at lower doses using it in mechanically ventilated septic shock patients an associated with increases in the Means±SDs of: SBPavg (101.87±10.00 mmHg vs. 94.33±9.17 mmHg); DBPavg (60.12±7.32 mmHg vs. 55.67±7.01 mmHg); and MAPavg (71.31±11.69 mmHg vs. 66.53±10.84 mmHg), respectively. And a significant reduction in SIavg (1.39±0.38 bpm/mmHg vs. 1.68±0.47 bpm/mmHg); and mSIavg (1.39±0.38 bpm/mmHg vs. 1.68±0.47 bpm/mmHg) compared to Norepinephrine.
Norepinephrine remains the mainstay treatment for septic shock and its shortages engender significant increases in mortality in patients with septic shock requiring the life-saving drug [9].
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