EFFECTS OF EPINEPHRINE ON HEMODYNAMICS AND OXYGEN-METABOLISM IN DOPAMINE-RESISTANT SEPTIC SHOCK

The hemodynamic effects of epinephrine were prospectively studied in 13 patients with septic shock who remained hypotensive after both fluid loading and dopamine. Hemodynamic measurements were performed before and one hour after the start of epinephrine infusion. Systolic, diastolic, and mean arterial pressure increased in all patients (p<0.01). Cardiac index and systemic vascular resistance increased by 34 and 32 percent, respectively (p<0.05), but heart rate and pulmonary vascular resistance remained unchanged. There was a concomitant increase in oxygen delivery (p<0.01) and oxygen consumption (p<0.05), the magnitude of the latter being related to baseline lactacidemia (p<0.01). In view of the generally recognized physiologic goals of septic shock management, we conclude that epinephrine could be an appropriate alternative where fluid loading and dopamine have failed.