Effects of norepinephrine on right ventricular function in septic shock patients

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Abstract
To study the effects of norepinephrine on right ventricular function in patients with hyperdynamic septic shock. Prospective, open study. A 15 bed ICU in a university hospital. 9 patients with hyperdynamic septic shock (SBP−1·m−2, SVRI≤850 dynes·s·cm−5m−2 and oliguria). Plasma volume expansion was used to correct a suspected volume deficit and then, norepinephrine infusion was started and titrated to restore systemic blood pressure to the normal range (mean infusion rate: 1.1±0.2 mcg·kg−1·min−1). Norepinephrine was the only vasoactive agent used in these patients. A modified Swan-Ganz catheter mounted with a fast response thermistor was inserted in each patient, allowing repeated measurements of RVEDVI and RVEF. At time of inclusion to the study, all but one patient had elevated MPAP (23±4 mmHg) and RVEF≤50%, and all patients had RVEDVI≥90 ml·m−2. During norepinephrine infusion, MAP increased from 51±9 to 89±10 mmHg (p−5·m−2 (p−2) was observed. A Frank-Starling relationship for the right ventricle was constructed by plotting an index of ventricular performance (RVSWI) against an index of ventricular preload (RVEDVI). A significant upward shift to the right of the relationship was observed during norepinephrine infusion. It was concluded that norepinephrine exerted a favourable effect on right ventricular function.