Epinephrine Is it really the black sheep of vasoactive agents.docVIP

Agrawal et al. Critical Care 2010,14:309 /content/14/3/309 JOURNAL CLUB CRITIQUE Epinephrine: Is it really the black sheep of vasoactive agents? Ritwick Agrawal , Ali Al-Khafaji and Sachin Yende* 1 2 2 University of Pittsburgh Department of Critical Care Medicine: Evidence-Based Medicine Journal Club, edited by Eric B Milbrandt Expanded abstract Citation Annane D, Vignon P, Renault A, Bollaert PE, Charpentier C, Martin C, Troche G, Ricard JD, Nitenberg G, Papazian L, Azoulay E, Bellissant E: Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial.Lancet 370:676-684 [1]. Background International guidelines for management of septic shock recommend that dopamine or norepinephrine are preferable to epinephrine. However, no large comparative trial has yet been done. Methods Objective: To compare the e?cacy and safety of norepinephrine plus dobutamine (whenever needed) with those of epinephrine alone in septic shock. Design: Prospective, multicenter, randomized, double-blind study. Setting: 19 participating intensive care units in France. Subjects: 330 adult patients with septic shock. Inclusion criteria were the presence for less than 7 days of: evidence of infection; at least 2 of the 4 criteria of systemic in?ammatory response syndrome (SIRS); and at least two signs of tissue hypoperfusion or organ dysfunction. Additionally, subjects had to have had to meet the three following criteria for less than 24 hours: systolic blood pressure less than 90 mm Hg or mean BP less than 70 mm Hg; administration of ?uid bolus of at least 1000 mL or capillary wedge pressure between 12 and 18 mm Hg; and need for more than 15 μg per kg bodyweight per min of dopamine or any dose of epinephrine or norepinephrine. Speci?c exclusion criteria were established to ensure other causes of shock were excluded. Intervention: Participants were ass