Norepinephrine In Patients Research Articles

Peripheral Use of Vasopressors in Shock: Clinical Considerations and Recommendations for Use in Obstetrics.

This study aimed to evaluate the safety of peripheral administration of vasopressor agents among patients with circulatory shock. We reviewed the published literature evaluating the use of peripheral norepinephrine in patients with shock and proposed a protocol for use in labor and delivery units. Peripheral administration of norepinephrine is a safe and potentially lifesaving intervention for patients in labor and delivery with extremely low complication rates. Adoption of a protocol for peripheral administration of vasopressors in labor and delivery is safe and may prevent life threatening delays in hemodynamic resuscitation. · Administering vasopressors through a peripheral line is safe and helps avoid delays in care.. · An established protocol is essential for the safe peripheral administration of vasopressors.. · Understanding continuous blood pressure monitoring is crucial for managing critically ill patients..

The influence of metoprolol in patients with sepsis-induced cardiomyopathy: A retrospective study.

To focus on evaluating the clinical influence of metoprolol on sepsis-induced cardiomyopathy (SICM). A total of 90 patients with SICM was enrolled from December 2018 to February 2021 and divided into 2 groups according to the use of metoprolol during hospitalization in Suzhou Municipal Hospital in Suzhou, China. We compared them with the cardiac function, sequential organ failure assessment score, and clinical outcomes. Between the 2 groups, the oxygenation indices and Glasgow coma scale in the metoprolol group were higher on the first day of treatment, with Glasgow coma scale higher on the third day of treatment. However, the doses of norepinephrine in patients with metoprolol showed no significant differences with the control group. The all-causemortality at 28 days in the metoprolol group was lower, and the time of removing from ventilator support as well as the number of failured organs also significantly differed between the 2 groups. Metoprolol can reduce the 28-day mortality and shorten the duration of mechanical ventilation in SICM. It can also reduce the number of organ failures and improve the oxygenation index and Glasgow coma scale of these patients. Meanwhile, metoprolol did not affect the norepinephrine dose in patients with SICM.

ВЗАИМОСВЯЗЬ ПОКАЗАТЕЛЕЙ НАПРЯЖЕННОСТИ СИМПАТОАДРЕНАЛОВОЙ СИСТЕМЫ У ПАЦИЕНТОВ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ ДО И ПОСЛЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ

Introduction. It is known that cardiovascular diseases, including cardiac arrhythmias, are accompanied by increased activation of the sympathetic-adrenal system (SAS). Hyperactivation of the SAS causes an increase in the level of circulating catecholamines - adrenaline and norepinephrine, resulting in desensitization of β-adrenergic receptors (β-AR), aggravation of myocardial contractile dysfunction and the development of arrhythmia. Indicators of SAS tension are β-adrenergic reactivity of erythrocyte membranes (β-ARM) and the level of circulating catecholamines. One of the most common arrhythmias is atrial fibrillation (AF), which leads to a decrease in the quality of life, disability and high mortality. Therefore, among patients with AF, it is important to study the functional viability of β-AR in different periods of the disease. Purpose: to evaluate β-ARM and the level of adrenaline, norepinephrine in patients with AF before and after surgical treatment. Materials and methods. The sample included 47 patients - 31 men and 16 women, the age in the sample was 51 (26; 77) years. All patients were diagnosed with AF based on ECG and 24-hour monitoring. Among the entire sample, 59.6% of patients had paroxysmal, 25.5% persistent, 14.9% long-term persistent forms of AF. All patients underwent surgical treatment of AF using radiofrequency or cryoablation. β-ARM was determined by the method of assessing changes in erythrocyte osmotic resistance as a result of blockade of β-AR in vitro with a selective β-adrenergic blocker (Β-ARM, AGAT, Russia). Plasma epinephrine and norepinephrine concentrations were determined by enzyme-linked immunosorbent assay using Adrenalin ELISA and Noradrenalin ELISA kits (Tecan IBL International, Germany). The parameters were studied in all patients before treatment, in 44 patients after 3 days, in 18 patients after 3 months and in 9 patients after 12 months after ablation. The significance of changes in β-ARM and catecholamine levels before and after ablation was assessed using the Wilcoxon test. The strength of the linear relationship between quantitative indicators was assessed using the Spearman rank correlation coefficient. Results. In the study sample, there were no statistically significant changes in β-ARM and adrenaline levels before and at different times after ablation. Thus, the level of β-ARM before surgery was 18.2 (12.6; 25.4), after 3 days - 22.3 (14.4; 26.6), after 3 months - 20.3 (9.3 ; 29.3), and 12 months after the operation - 27.7 (16.8; 36.7). The level of adrenaline before surgery, 3 days, 3 months and 12 months after surgery was 4.4 (3.7; 6.9), 4.7 (3.0; 6.4), 4.6 (2 .5; 6.6), 5.6 (9.1; 8.8). However, an increase in the level of norepinephrine was found 12 months after ablation compared with the values before treatment and 3 days after treatment by 1.7 and 1.8 times, respectively (p = 0.028). The level of norepinephrine before surgery, 3 days, 3 months and 12 months after surgery was 40.9 (18.7; 56.6), 38.6 (14.8; 49.6), 46.7 (25 .6; 57.3), 69.3 (65.1; 80.1). Before surgery, β-ARM and norepinephrine levels were linearly correlated (r = 0.335, p = 0.037), but after treatment, the linear correlation disappeared. At 3 and 12 months after ablation, there was a strong linear correlation between adrenaline and norepinephrine levels (r = 0.611, p = 0.012; r = 0.786, p = 0.036, respectively). Conclusion. In the sample of patients with AF, β-ARM and norepinephrine levels were linearly correlated before treatment, but after ablation, the correlation disappeared. At the same time, the values of β-ARM do not change statistically significantly, and the level of norepinephrine increases during a 12-month follow-up. Thus, 12 months after treatment in patients with AF, the activity of the CAS increases, but the functional viability of beta-AR does not change significantly.

Norepinephrine combined with phenylephrine versus norepinephrine in patients with septic shock: a retrospective cohort study

BackgroundPhenylephrine (PE) and norepinephrine (NE) may be used to maintain adequate blood pressure and tissue perfusion in patients with septic shock, but the effect of NE combined with PE (NE-PE) on mortality remains unclear. We hypothesized that NE-PE would not inferior to NE alone for all-cause hospital mortality in patients with septic shock.MethodsThis single-center, retrospective cohort study included adult patients with septic shock. According to the infusion type, patients were divided into the NE-PE or NE group. Multivariate logistic regression, propensity score matching and doubly robust estimation were used to analyze the differences between groups. The primary outcome was the all-cause hospital mortality rate after NE-PE or NE infusion.ResultsAmong 1, 747 included patients, 1, 055 received NE and 692 received NE-PE. For the primary outcome, the hospital mortality rate was higher in patients who received NE-PE than in those who received NE (49.7% vs. 34.5%, p < 0.001), and NE-PE was independently associated with higher hospital mortality (odds ratio = 1.76, 95% confidence interval = 1.36–2.28, p < 0.001). Regarding secondary outcomes, patients in the NE-PE group had longer lengths of stay in ICU and hospitals. Patients in the NE-PE group also received mechanical ventilation for longer durations.ConclusionsNE combined with PE was inferior to NE alone in patients with septic shock, and it was associated with a higher hospital mortality rate.

The Effect of Pharmacologically Induced Blood Pressure Manipulation on Cardiac Output and Cerebral Blood Flow Velocity in Patients with Aneurysmal Subarachnoid Hemorrhage.

Vasopressors are used in patients with subarachnoid hemorrhage (SAH) to increase blood pressure with the idea of reversing the ischemic process. The current study is designed to evaluate the changes in systemic and cerebral hemodynamics, including cerebral blood flow autoregulation, at different pharmacologically augmented blood pressure levels using norepinephrine in patients with spontaneous aneurysmal SAH following surgery. This prospective observational study was carried out in patients with ruptured anterior circulation aneurysms who underwent surgical clipping and required norepinephrine infusion. Postoperatively, when the treating physician decided to start a vasopressor, norepinephrine infusion was started at 0.05 µg/kg/min. The infusion rate was increased by 0.05 µg/kg/min every 5 minutes to achieve a 20% and then 40% increase in the systolic blood pressure (SBP). When the blood pressure stabilized at each level for 5 minutes, hemodynamic and transcranial doppler (TCD) parameters in the middle cerebral artery (MCA) were recorded. Peak systolic, end-diastolic, and mean flow velocities in the MCA increased with targeted blood pressure increase in the hemispheres with impaired autoregulation and not in the hemispheres with intact autoregulation. The interaction of changes in TCD flow velocities between hemispheres with and without intact autoregulation was significant (p < 0.001). Cardiac output changes following norepinephrine infusion were not significant (p = 0.113). Hypertensive therapy with norepinephrine increases cerebral blood flow velocity only when autoregulation is impaired, an effect that is desirable in patients with focal cerebral ischemia following SAH. Lakshmegowda M, Muthuchellapan R, Sharma M, Ganne SUR, Chakrabarti D, Muthukalai S. The Effect of Pharmacologically Induced Blood Pressure Manipulation on Cardiac Output and Cerebral Blood Flow Velocity in Patients with Aneurysmal Subarachnoid Hemorrhage. Indian J Crit Care Med 2023;27(4):254-259.

Retracted: Effects of Collagen Antibacterial Functional Dressing plus Continuous Nursing on Lower Extremity Skin Injury Caused by Norepinephrine in Patients with Septic Shock.

[This retracts the article DOI: 10.1155/2022/4160637.].

Effects of Collagen Antibacterial Functional Dressing plus Continuous Nursing on Lower Extremity Skin Injury Caused by Norepinephrine in Patients with Septic Shock.

Background This study was designed to explore the effects of collagen antibacterial functional dressing plus continuous care on norepinephrine-induced lower extremity skin injury in patients with septic shock. Methods In this prospective, randomized, controlled study, 120 patients with septic shock receiving norepinephrine in our hospital from February 2020 to February 2021 were recruited. All the enrollments were randomized into the experimental group (n = 60) and the control group (n = 60). The control group received continuous care, while the experimental group additionally received collagen antibacterial functional dressing. Outcome measures included skin sensation scores, incidence of lower extremity skin injuries, recovery time, inflammatory factor levels, and care satisfaction. Results Collagen antibacterial functional dressing plus continuous care resulted in significantly lower skin sensation scores and a lower incidence of skin injuries versus continuous care alone. Patients in the experimental group had faster recovery of lower extremity skin injury than those in the control group. Collagen antibacterial functional dressing plus continuous care was associated with significantly lower levels of inflammatory factors and a higher satisfaction rate than continuous care alone. Conclusion Collagen antibacterial functional dressing plus continuous care improves the local skin condition of patients with septic shock receiving norepinephrine, regulates the levels of inflammatory factors, reduces the risk of skin injuries, and enhances care satisfaction.

Prehospital norepinephrine administration reduces 30-day mortality among septic shock patients

BackgroundDespite differences in time of sepsis recognition, recent studies support that early initiation of norepinephrine in patients with septic shock (SS) improves outcome without an increase in adverse effects. This study aims to investigate the relationship between 30-day mortality in patients with SS and prehospital norepinephrine infusion in order to reach a mean blood pressure (MAP) > 65 mmHg at the end of the prehospital stage.MethodsFrom April 06th, 2016 to December 31th, 2020, patients with SS requiring prehospital Mobile Intensive Care Unit intervention (MICU) were retrospectively analysed. To consider cofounders, the propensity score method was used to assess the relationship between prehospital norepinephrine administration in order to reach a MAP > 65 mmHg at the end of the prehospital stage and 30-day mortality.ResultsFour hundred and seventy-eight patients were retrospectively analysed, among which 309 patients (65%) were male. The mean age was 69 ± 15 years. Pulmonary, digestive, and urinary infections were suspected among 44%, 24% and 17% patients, respectively. One third of patients (n = 143) received prehospital norepinephrine administration with a median dose of 1.0 [0.5–2.0] mg h−1, among which 84 (69%) were alive and 38 (31%) were deceased on day 30 after hospital-admission. 30-day overall mortality was 30%. Cox regression analysis after the propensity score showed a significant association between prehospital norepinephrine administration and 30-day mortality, with an adjusted hazard ratio of 0.42 [0.25–0.70], p < 10–3. Multivariate logistic regression of IPTW retrieved a significant decrease of 30-day mortality among the prehospital norepinephrine group: ORa = 0.75 [0.70–0.79], p < 10–3.ConclusionIn this study, we report that prehospital norepinephrine infusion in order to reach a MAP > 65 mmHg at the end of the prehospital stage is associated with a decrease in 30-day mortality in patients with SS cared for by a MICU in the prehospital setting. Further prospective studies are needed to confirm that very early norepinephrine infusion decreases septic shock mortality.

Early initiation of norepinephrine in patients with septic shock: A propensity score-based analysis.

The use of vasopressors is vital in septic shock. However, the optimal timing of treatment remains unclear. Therefore, we aimed to explore the impact of early norepinephrine initiation on the survival of patients with septic shock. We selected 4253 patients from the Medical Information Mart for Intensive Care IV database between 2008 and 2019. The primary outcome was 28-day mortality. Propensity score matching (PSM) was applied to minimize between-group imbalances, and a restricted mean survival time was used to quantify the beneficial impact of early norepinephrine treatment on survival. Sensitivity analyses were conducted to test the robustness of the study results in multiple cohorts. In the PSM cohort, 2862 patients were equally assigned to early (receiving norepinephrine within the first 3 h) and delayed (> 3 h) norepinephrine initiation groups. Patients in the early norepinephrine initiation group received significantly less fluid therapy (0 vs. 79 mL/kg), had lower 28-day mortality (30.0% vs. 37.8%), longer survival days (21.89 vs. 20.37 days), shorter duration of intensive care unit (4.9 vs. 7.2 days) and hospital stays (12.4 vs. 13.6 days), shorter duration of supportive norepinephrine and invasive mechanical ventilation, lower incidence of organ failure progression (64.4% vs. 79.2%) within 24 h after shock onset, and higher mean arterial pressure within 6 and 24 h after shock onset than patients in the delayed norepinephrine initiation group (p < 0.05). Norepinephrine initiation within the first 3 h, regardless of preload dependency, was associated with longer survival time and shorter duration of supportive norepinephrine and invasive mechanical ventilation and may delay or partially reverse rapid onset organ failure.

Clinical Update on Vasopressors and Titration Strategies.

Clinical Update on Vasopressors and Titration Strategies.

Association Between Vasopressin Rebranding and Utilization in Patients With Septic Shock.

Vasopressin is suggested as an adjunct to norepinephrine in patients with septic shock. However, after vasopressin was rebranded in November 2014, its cost exponentially increased. Utilization patterns of vasopressin after its rebranding are unclear. The objective of this study was to determine if there is an association between the rebranding of vasopressin in November 2014 and its utilization in vasopressor-dependent patients with severe sepsis or septic shock. Retrospective, multicenter, database study between January 2010 and March 2017. Premier Healthcare Database hospitals. Adult patients admitted to an ICU with severe sepsis or septic shock, who received at least one vasoactive agent for two or more calendar days were included. The proportion of patients who received vasopressin and vasopressin cost was assessed before and after rebranding, and evaluated with segmented regression. Among 294,733 patients (mean age, 66 ± 15 yr), 27.8% received vasopressin, and ICU mortality was 26.5%. The proportion of patients receiving vasopressin was higher after rebranding (31.2% postrebranding vs 25.8% prerebranding). Before vasopressin rebranding, the quarterly proportion of patients who received vasopressin had an increasing slope (prerebranding slope 0.41% [95% CI, 0.35-0.46%]), with no difference in slope detected after vasopressin rebranding (postrebranding slope, 0.47% [95% CI, 0.29-0.64%]). After vasopressin rebranding, mean vasopressin cost per patient was higher ($527 ± 1,130 vs $77 ± 160), and the quarterly slope of vasopressin cost was higher (change in slope $77.18 [95% CI, $75.73-78.61]). Total vasopressin billed cost postrebranding continually increased by ~$294,276 per quarter from less than $500,000 in Q4 2014 to over $3,000,000 in Q1 2017. After vasopressin rebranding, utilization continued to increase quarterly despite a significant increase in vasopressin cost. Vasopressin appeared to have price inelastic demand in septic shock.

Metastatic pheochromocytoma and paraganglioma: signs and symptoms related to catecholamine secretion

BackgroundThe presence or future development of metastatic pheochromocytomas or paragangliomas (mPPGLs) can be difficult to diagnose or predict at initial presentation. Since production of catecholamines from mPPGLs is different from non-metastatic tumors (non-mPPGLs), this study aimed to clarify whether presenting catecholamine-related signs and symptoms (cSS) might also differ.MethodsThe study included 249 patients, 43 with mPPGL and 206 with non-mPPGL. Clinical data at the time of biochemical diagnosis (i.e. at entry into the study) were used to generate a cumulative score of cSS for each patient.ResultsPatients with mPPGL were significantly younger (43.3 ± 14 vs. 48.9 ± 16.1 years) and included a lower proportion of females (39.5% vs. 60.7%) than patients with non-mPPGLs. Frequencies of signs and symptoms did not differ between the two groups. Patients with mPPGLs had lower (P < 0.001) urinary excretion of epinephrine (3.5 (IQR, 1.9—6.5) µg/day) than those with non-mPPGLs (19.1 (IQR, 4.3—70.2) µg/day). There was no difference in urinary excretion of norepinephrine. In patients with mPPGLs a high cSS score was associated with high urinary excretion of norepinephrine and normetanephrine. In contrast, in patients with non-mPPGLs, a high cSS was associated with high urinary excretion of epinephrine and metanephrine.ConclusionAlthough presenting signs and symptoms were associated with production of norepinephrine in patients with mPPGLs and of epinephrine in patients with non-mPPGLs, there were no differences in signs and symptoms between the two groups. Therefore, consideration of signs and symptoms does not appear helpful for distinguishing patients with and without mPPGLs.

Two-component vasopressor therapy for septic shock

The objective: to investigate the efficacy and safety of terlipressin when it is used as an additional vasopressor in septic shock.Subjects: A single-center, observational, retrospective-prospective study of the efficacy and safety of combined therapy of septic shock with norepinephrine and terlipressin versus monotherapy with norepinephrine was conducted.Results. The use of terlipressin made it possible to reduce the average daily need for noradrenaline in patients with septic shock from 0.68 μg · kg-1 · min-1 in the control group to 0.55 μg · kg-1 · min-1 in the study group (p = 0.015) and reduce the duration of vasopressor support from 8 days [6.0-11.0] to 6 days [5.0-8.0] in the study group (p = 0.023). The use of terlipressin did not reduce the need for mechanical ventilation, but it did reduce the duration of ventilation. The number of days free from mechanical ventilation in patients in the control group was 6.0 [1.0-18.0], in the study group - 16.0 [2.0-22.0], (p = 0.039).Conclusion. The use of terlipressin as a supplement to norepinephrine is an effective and relatively safe treatment for hypotension in refractory septic shock.

Safety of administration of norepinephrine through peripheral vein line in patients with septic shock

To analysis the risk factors and safety of administration of norepinephrine (NE) via peripheral vein line (PVL) in patients with septic shock. A single-center retrospective study was conducted. According to the Lanzhou University Second Hospital information system (HIS) and nursing adverse events report cards, patients with septic shock administrated with NE via PVL to correct the hypotension from January 1st 2015 to December 31st, 2019 were enrolled. The patients' general information, placement location of peripheral venous catheter and venousneedle type, characteristics of NE usage and patient general condition when extravasation occurred were collected. The univariate analysis and Logistic regression were used to analyze risk factors associated with extravasation. Also, the receiver operator characteristic curve (ROC curve) was drawn, and the predictive value of risk factors for extravasation was analyzed. A total of 1 022 cases with NE were enrolled. After a preliminary screening, a total of 910 cases with NE were used to correct low blood pressure, including 116 cases of peripheral venous infusion. The average age was (52.91±18.69) years old, with majority of female (77 cases, 66.4%). Basic diseases were mainly chronic obstructive pulmonary disease (COPD, 100 cases, 86.2%), followed by hypertension (91 cases, 78.4%), coronary heart disease (87 cases, 75.0%), type 2 diabetes (74 cases, 63.8%) respectively, the primary disease was septic shock in 109 cases (94.0%). A total of 147 peripheral venous catheters were inserted, and the most common site of puncture was the forearm [78.9% (116/147)], followed by the hand [12.2% (18/147)] and the median cubital vein [8.8% (13/147)]. 89.9% of the needles were 20 G in diameter, and 75 cases (64.7%) were converted to central venous catheters (CVC) during subsequent treatment due to continuous infusion of NE. Six patients (5.2%) had extravasation, the median time of extravasation was 29 (23-39) hours, and the median time of NE was 23 (11-53) hours, including 2 patients with an infusion concentration of 60 mg/L and 4 patients with an infusion concentration of 120 mg/L.The infusion speed was 0.5-1.0 μg×kg-1×min-1, and the average speed of infusion was (0.75±0.04) μg×kg-1×min-1 when extravasation. Univariate and binary Logistic regression analysis showed that the risk factors related to the occurrence of extravasation included: (1) patient factors: the presence of basic diseases, hypertension [odds ratio (OR) = 3.11, 95% confidence interval (95%CI) was 3.09-3.12, P = 0.001] and edema (OR = 1.79, 95%CI was 1.32-2.99, P = 0.032). (2) Factors of infusion fluid itself: long-term (> 24 hours) infusion (OR = 2.91, 95%CI was 1.04-5.96, P = 0.040), infusion concentration > 60 mg/L (OR = 1.88, 95%CI was 1.32-3.99, P = 0.024), infusion speed > 0.3 μg×kg-1×min-1 (OR = 2.43, 95%CI was 2.38-2.51, P = 0.029) and diameter of needles < 20 G (OR = 3.11, 95%CI was 3.09-3.22, P = 0.033). (3) Medical personnel factors: lack of observation and assessment (OR = 1.09, 95%CI was 1.03-6.77, P = 0.043). The ROC curve analysis showed that: edema, long-term infusion (> 24 hours), infusion rate > 0.3 μg×kg-1×min-1 and diameter of needles < 20 G had a certain predictive value for extravasation of NE through peripheral venous infusion in patients with septic shock, the area under ROC curve (AUC) was 0.610, 0.762, 0.672, 0.629, 95%CI was 0.508-0.713, 0.675-0.849, 0.571-0.772, 0.525-0.732, and P values were 0.044, 0.000, 0.002, 0.019, respectively. Hypertension, edema, long-term infusion (> 24 hours), infusion concentration > 60 mg/L, infusion speed > 0.3 μg×kg-1×min-1, diameter of needle < 20 G, and lack of observation and evaluation by medical staff regularly were risk factors affecting the safety of peripheral intravenous NE in patients with septic shock. Peripheral NE should be avoided in the presence of the above risk factors.

Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis.

IntroductionMost experts recommend norepinephrine as the first-line agent in septic shock. Our objective was to determine the effectiveness and safety of norepinephrine in patients with septic shock.MethodsWe searched the Cochrane Central Register of Controlled Trials and Epistemonikos, as well as MEDLINE from 1966 till August 2019. Screening of full texts, evaluation for eligibility, and data extraction were done by four independent reviewers. We estimated risk ratios (RR) and mean differences (MD) using a random-effects model with 95% confidence intervals (CI). The primary outcomes included the number of participants who achieved the target mean arterial pressure (MAP), time to achieve the target MAP, and number of participants with all-cause 28-day mortality. The secondary outcomes included the length of stay in the intensive care unit, length of hospital stay, incidence of arrhythmia and myocardial infarction, vasopressor-free days, and number of participants with all-cause 90-day mortality.ResultsWe identified 11 randomized controlled trials with a total of 4,803 participants. There was no difference in the number of participants who achieved the target MAP between those patients receiving norepinephrine and other vasopressors (RR 1.44; 95% CI, 0.32 to 6.54; P = 0.640; I2 = 94%; two trials, 116 participants). There was no significant difference in time to achieve the target MAP (MD −0.05; 95%, CI, −0.32 to 0.21; P = 0.690; I2 = 26%; two trials, 1763 participants) and all-cause 28-day mortality (RR 0.95; 95% CI, 0.89 to 1.02; P = 0.160; I2 = 0%; seven trials, 4,139 participants). Regarding the secondary outcome, norepinephrine may significantly reduce the incidence of arrhythmia as compared to other vasopressors (RR 0.64; 95% CI, 0.42 to 0.97; P = 0.030; I2 = 64%; six trials, 3974 participants). There was no difference in the incidence of myocardial infarction (RR 1.28; 95% CI, 0.79 to 2.09), vasopressor-free day (RR 0.46; 95% CI, −1.82 to 2.74) and all-cause 90-day mortality (RR 1.08; 95% CI, 0.96 to 1.21) between norepinephrine and vasopressors.ConclusionIn minimizing the occurrence of an arrhythmia, norepinephrine is superior to other vasopressors, making it safe to be used in septic shock. However, there was insufficient evidence concerning mortality and achievement of the target MAP outcomes.

Association of working memory and elevated overnight urinary norepinephrine in patients with schizophrenia

IntroductionNorepinephrine has both central and peripheral origins and is known to influence cognitive processes in attention, learning, and working memory, but the research regarding the impact of norepinephrine on cognition in schizophrenia remains sparse, and mainly focuses on centrally regulated noradrenergic effects. This study examined the relationship between cumulative overnight norepinephrine levels in the urine and working memory in patients with schizophrenia and healthy controls. MethodsUrinary catecholamines were collected overnight in patients with schizophrenia (n = 75) and healthy controls (n = 33). Working memory was assessed using the digit sequencing task. ResultsPatients showed significantly higher average levels of overnight norepinephrine (t(103.10) = −3.16, p = 0.002) and reduced working memory performance (t(90) = 3.87, p = 0.001) compared with healthy individuals. There was a significant negative correlation between norepinephrine and working memory in patients (r = −0.38, p = 0.005), but not in controls (r = 0.08, p = 0.67). After controlling for age, sex, antipsychotic medications, and serotonin-norepinephrine reuptake inhibitor-based antidepressants, the correlation remained significant (r = −0.41, p = 0.004). ConclusionsHigh peripheral overnight levels of urinary norepinephrine are associated with lower working memory performance in patients with schizophrenia. These results parallel previous studies suggesting that high levels of central norepinephrine may result in working memory impairments. As norepinephrine rapidly breaks down and usually does not pass through the blood-brain barrier, the potential effect of peripheral cumulative norepinephrine on working memory is intriguing, and needs to be further investigated.

Effects of spironolactone and eplerenone on left ventricular diastolic function and neurohumoral factors in patients with heart failure

Aim. To study the effects of spironolactone and eplerenone on left ventricular diastolic function and neurohumoral factors in patients with heart failure (HF).Material and methods. We examined 131 patients with coronary artery disease and NYHA class I-III HF. Patients were randomized into groups depending on HF class: class I (n=31), class II (n=51) and class III (n=49).Results. The study revealed that the clinical course of HF and LV diastolic dysfunction are associated with an increased level of neurohormones and are characterized by significantly high levels of aldosterone and norepinephrine in patients with a restrictiveLV diastolic dysfunction. A correlation was found between the level of neurohormones (aldosterone and norepinephrine) and heart remodeling parameters: an inverse correlation with an ejection fraction (r=-0,68, r=-0,61, respectively) and a direct correlation with LV end-diastolic volume (r=0,58, r=0,66, respectively). Long-term treatment with spironolactone and eplerenone had a positive effect, reducing the level of mentioned neurohormones. In patients with class II HF, both drugs had a positive effect on the level of aldosterone and norepinephrine, reducing them by 26,6% and 20,2% in the spironolactone group and by 28,4% and 24,6% in the eplerenone group, respectively. In patients with class III HF, the decrease in aldosterone level was more pronounced in those taking eplerenone than spironolactone: 32,1% vs 20,2%, respectively.Conclusion. In patients with HF, combination therapy with the inclusion of spironolactone significantly reduced the level of neurohormones mainly in patients with class II HF and, to a lesser extent, in those with class III HF. This suggests that combination therapy with spironolactone is less effective than with eplerenone in relation to neurohormones’ levels.

Plasma cerebellin levels in patients with central serous chorioretinopathy

PurposeTo evaluate levels of plasma cerebellin, cortisol, adrenaline and noradrenaline in patients with central serous chorioretinopathy (CSC). Materials and MethodsThis prospective study included 30 patients diagnosed with acute CSC (Group 1) and a control group of 30 age-matched, healthy subjects without CSC (Group 2). Levels of plasma cerebellin, cortisol, adrenaline and noradrenaline were examined in blood samples taken after 8-12hours of fasting. A value of p<0.05 was considered statistically significant in the comparative analyses. ResultsThe mean plasma cerebellin level was found to be 232.56±113.28 pg/ml in Group 1 and 174.07±82.04 pg/ml in Group 2 (p=0.02). Mean plasma cortisol was 13.19±3.87μg/ml in Group 1 and 9.55±2.92μg/ml in Group 2 (p<0.01). Mean plasma adrenaline was 60.62±26.67 pg/ml in Group 1 and 46.17±19.20 pg/ml in Group 2 (p=0.03). Mean plasma noradrenaline was 206.66±73.90 pg/ml in Group 1 and 149.96±51.36 pg/ml in Group 2 (p<0.01). ConclusionIt can be concluded that increased cerebellin may have a role in the etiology of CSC by increasing catecholamine expression from the adrenal medulla and indirectly by increasing cortisol levels via a paracrine effect from the adrenal cortex.

Effect of Phenylephrine Push Before Continuous Infusion Norepinephrine in Patients With Septic Shock

IV pushes of phenylephrine may be used for patients with septic shock with the intent of rapidly achieving mean arterial pressure (MAP) goals. However, the clinical effectiveness and safety of this approach are unclear. In patients with septic shock, is administration of a phenylephrine push before norepinephrine initiation associated with a higher incidence of hemodynamic stability? This retrospective, multicenter cohort study included adult patients with septic shock initiated on norepinephrine. Propensity scores for initial phenylephrine push receipt were generated, and patients receiving an initial phenylephrine push were propensity score-matched 1:2 to those not receiving an initial phenylephrine push. The primary outcome was achievement of hemodynamic stability (defined as maintaining MAP of≥ 65mmHg for at least 6h without an increase in continuous infusion vasoactive agent dosage) within 3 and 12h of norepinephrine initiation. Of 1,317 included patients, 181 received an initial phenylephrine push; 141 phenylephrine push patients were matched to 282 patients not receiving a phenylephrine push. More patients who received a phenylephrine push achieved hemodynamic stability at hour 3 than those who did not receive a phenylephrine push (28.4%vs18.8%; risk difference, 10%; 95%CI, 0.9%-18%). Phenylephrine push receipt was associated independently with hemodynamic stability within 3h (adjusted OR, 1.8; 95%CI, 1.09-2.97), but not at 12h (adjusted OR, 1.42; 95%CI, 0.93-2.16). Phenylephrine push receipt was associated independently with higher ICU mortality (adjusted OR, 1.88; 95%CI, 1.1-3.21). Phenylephrine pushes were associated with a higher incidence of early, but not sustained, hemodynamic stability and were associated independently with higher ICU mortality. Caution is warranted when clinicians are considering the use of phenylephrine pushes in patients with septic shock.

Blood norepinephrine/epinephrine/dopamine measurements in 108 patients with takotsubo syndrome from the world literature: pathophysiological implications

Objectives Release of norepinephrine (NE) from neuronal cardiac nerve endings and/or blood-borne catecholamines (CATs), mainly epinephrine (EPI), may mediate TTS. The aim of this study was to document the levels of NE, EPI, and dopamine (DA) in patients with TTS. Materials and methods A qualitative/quantitative meta-analysis of CATs and their relationship to age, gender, and triggers, was carried out, employing the world literature on TTS, published in PubMed. Results NE/EPI/DA in108 patients with TTS, 65.2 ± 16.4 years old, 89 (82.4%) women, revealed that: NE was measured more frequently than EPI, and EPI than DA; the timing of the measurements was variable; CATs were reported variably (qualitatively/quantitatively/with/without upper limits of normal); NE/EPI or NE/EPI/DA rose to the same degree; CATs were normal, or mildly/moderately elevated, with only 6 patients showing markedly elevated NE/EP/DA; NE, EPI, and DA were similar in patients with physical triggers and NE was similar in patients with physical, emotional, or no triggers (p = 0.47); EPI was higher than NE in patients with emotional triggers and EPI was higher in patients with emotional than physical triggers (p = 0.012); NE, EPI, and DA rose to the same proportion in men and women; types of TTS triggers were distributed proportionally in men and women. Conclusion NE, EPI, and DA rise proportionally in patients with TTS; CATs are mildly/moderately, and rarely markedly elevated; measurements of CATs should become more systematised; although CATs may not be essential for TTS diagnosis, they may contribute to prognosis and elucidation of the pathophysiology of TTS.