@article{3062834,
    title = "Refractory septic shock: Efficacy and safety of very high doses of norepinephrine",
    author = "Katsaragakis, S. and Kapralou, A. and Theodorou, D. and Markogiannakis, H. and Larentzakis, A. and Stamou, K.M. and Drimousis, P. and Bramis, I.",
    journal = "Methods and Findings in Experimental and Clinical Pharmacology",
    year = "2006",
    volume = "28",
    number = "5",
    pages = "307-313",
    issn = "0379-0355",
    doi = "10.1358/mf.2006.28.5.990203",
    keywords = "antibiotic agent;  catecholamine;  noradrenalin, acute pancreatitis;  adult;  aged;  arterial pressure;  central venous pressure;  clinical article;  controlled study;  dose response;  drug effect;  drug efficacy;  drug megadose;  drug safety;  female;  human;  intensive care unit;  lung capillary pressure;  male;  peritonitis;  review;  septic shock;  survival rate;  systemic vascular resistance, Aged;  APACHE;  Blood Pressure;  Dose-Response Relationship, Drug;  Female;  Heart Rate;  Humans;  Male;  Middle Aged;  Norepinephrine;  Retrospective Studies;  Shock, Septic;  Vasoconstrictor Agents",
    abstract = "The aim of Ms study was to evaluate the safety, efficacy, and effects of administration of very high doses of norepinephrine (>4 μg kg-1 min-1) in catecholamine-resistant septic shock. We reviewed the charts of all patients with nonresponding to commonly used norepinephrine doses (≤4 μg kg-1 min-1) septic shock from January 1999 to December 2002 in our Surgical Intensive Care Unit. All patients were treated with high norepinephrine doses (>4 μg kg-1 min-1), after initial resuscitation, so as to achieve a mean arterial pressure higher than or equal to 65 mmHg. During this 4-year period, 12 consecutive patients with catecholamine-resistant septic shock were included in our study. When compared with the values obtained prior to the administration of very high norepinephrine doses, the values of mean arterial pressure (p = 0.003) and systemic vascular resistance (p = 0.002) significantly increased after the administration of such doses, and additionally, lactate concentrations (p = 0.003) decreased. In contrast, no significant changes were observed regarding mean central venous pressure, pulmonary capillary wedge pressure, and pulmonary arterial pressure. Administration of high norepinephrine doses in our patients resulted in a survival rate of 33.4%. Management of catecholamine-resistant septic shock patients poses a challenging problem. Administration of very high norepinephrine doses is safe and effective and may improve survival of these patients with otherwise extremely high mortality rates. © 2006 Prous Science. All rights reserved."
}