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Phenylephrine versus norepinephrine for initial hemodynamic support of patients with septic shock: a randomized, controlled trial

Andrea Morelli1*, Christian Ertmer2, Sebastian Rehberg2, Matthias Lange2, Alessandra Orecchioni1, Amalia Laderchi1, Alessandra Bachetoni3, Mariadomenica D'Alessandro3, Hugo Van Aken2, Paolo Pietropaoli1 and Martin Westphal2

Author Affiliations

1 Department of Anesthesiology and Intensive Care, University of Rome, 'La Sapienza', Viale del Policlinico 155, Rome 00161, Italy

2 Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Straße 33, Muenster 48149, Germany

3 Laboratory of Clinical Pathology, Department of Surgery, University of Rome, 'La Sapienza', Viale del Policlinico 155, Rome 00161, Italy

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Critical Care 2008, 12:R143  doi:10.1186/cc7121

Published: 18 November 2008

Abstract

Introduction

Previous findings suggest that a delayed administration of phenylephrine replacing norepinephrine in septic shock patients causes a more pronounced hepatosplanchnic vasoconstriction as compared with norepinephrine. Nevertheless, a direct comparison between the two study drugs has not yet been performed. The aim of the present study was, therefore, to investigate the effects of a first-line therapy with either phenylephrine or norepinephrine on systemic and regional hemodynamics in patients with septic shock.

Methods

We performed a prospective, randomized, controlled trial in a multidisciplinary intensive care unit in a university hospital. We enrolled septic shock patients (n = 32) with a mean arterial pressure below 65 mmHg despite adequate volume resuscitation. Patients were randomly allocated to treatment with either norepinephrine or phenylephrine infusion (n = 16 each) titrated to achieve a mean arterial pressure between 65 and 75 mmHg. Data from right heart catheterization, a thermodye dilution catheter, gastric tonometry, acid-base homeostasis, as well as creatinine clearance and cardiac troponin were obtained at baseline and after 12 hours. Differences within and between groups were analyzed using a two-way analysis of variance for repeated measurements with group and time as factors. Time-independent variables were compared with one-way analysis of variance.

Results

No differences were found in any of the investigated parameters.

Conclusions

The present study suggests there are no differences in terms of cardiopulmonary performance, global oxygen transport, and regional hemodynamics when phenylephrine was administered instead of norepinephrine in the initial hemodynamic support of septic shock.

Trial registration

ClinicalTrial.gov NCT00639015