Epinephrine kinetics in septic shock – a means to understand variable catecholamine efficiency.docVIP

Available online /content/13/4/177 Commentary Epinephrine kinetics in septic shock - a means to understand variable catecholamine efficiency? Enrico Calzia1, Michael Georgieff1, Markus Huber-Lang2 and Peter Radermacher1 1Sektion An?sthesiologische Pathopyhsiologie und Verfahrensentwicklung, Klinik für An?sthesiologie, Parkstrasse 11, 89073 Ulm, Germany 2Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universit?tsklinikum, Steinh?velstrasse 9, 89075 Ulm, Germany Corresponding author: Peter Radermacher, peter.radermacher@uni-ulm.de Published: 13 August 2009 Critical Care 2009, 13:177 (doi:10.1186/cc7987) This article is online at /content/13/4/177 ? 2009 BioMed Central Ltd See related research by Abboud et al., /content/13/4/R120 Abstract effect, even at high infusion rates, and were directly related to the body weight and inversely related to the severity of the disease (according to the new Simplified Acute Physiologic Score (SAPS II)); however, neurohormonal status had no impact on them. It is well-established that the hemodynamic response to infusing catecholamines, the most frequently applied drugs for circulatory support during shock states, may vary markedly within and between individuals. In this context it is striking that only scarce data are available on the pharmacokinetics of catecholamines in critically ill patients. Furthermore, the existing literature comprises fairly equivocal observations. Abboud and colleagues now report that, in patients with septic shock, epinephrine kinetics are linear and its clearance directly depends on body weight and is inversely related to the severity of the disease. The authors conclude that the endogenous adrenal axis hormones do not assume any additional importance. How does Abboud and colleagues’ study compare with the existing literature? As could be expected from the extremely variable pharm