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Norepinephrine: more than blood pressure cosmetics?

Introduction

Norepinephrine (NE) is used to increase blood pressure (mean arterial pressure (MAP)) if hypotension arises. Increasing the perfusion pressure may increase blood flow in regions at risk. But vasoconstriction might worsen microcirculatory flow. We investigated the effects of NE on systemic, splanchnic and microcirculatory (microvascular blood flow (MBF)) blood flow in hypotensive pigs after major surgery.

Methods

Twenty-seven pigs (30 ± 3 kg) were anesthetized, ventilated and underwent laparotomy. They were randomized to one of the following treatments: Group Low received 3 ml/kg/hour Ringer's lactate (RL) throughout the study. Group H received hydroxyethyl starch (130/0.4) to maintain SvO2 ≥ 60%. Group NE received 3 ml/kg/hour RL and NE to increase blood pressure to 65 and to 75 mmHg to match the MAP of Group H. Systemic, splanchnic, MBF blood flow and intestinal tissue oxygen tension were measured.

Results

Baseline MAP was similar in all groups. To increase MAP to 65 and 75 mmHg, 0.035 and 0.12 μg/kg/minute NE were needed, respectively. The effects of NE on blood pressure, systemic, regional and MBF blood flow are shown in Figures 1 and 2.

Figure 1
figure1

Target MAP 65 mmHg (mean ± SD).

Figure 2
figure2

Target MAP 75 mmHg (mean ± SD).

Conclusion

NE increased MAP efficiently but had no beneficial effects on regional or MBF in the splanchnic region. This suggests that administration of vasopressors such as NE could be an unsafe way to maintain MAP because it may leave intestinal hypoperfusion undetected.

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Hiltebrand, L., Brandt, S., Kimberger, O. et al. Norepinephrine: more than blood pressure cosmetics?. Crit Care 13, P180 (2009). https://doi.org/10.1186/cc7344

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Keywords

  • Norepinephrine
  • Mean Arterial Pressure
  • Hydroxyethyl
  • Increase Blood Pressure
  • Intestinal Tissue