INOTROPIC TREATMENT IN SEPTIC SHOCK
ENVER OKAN HAMAMCI, RÜÇHAN AKAR, FEYZAN ERCAN, ATİLA KORKMAZ
Anadolu Üniversitesi Tıp Fakültesi, Genel Cerrahi Kliniği, ESKİŞEHİR
Inotropic therapy for treating septic shock was carried out in 13 patients with persistent hypotension between July 1990 and February 1992. Dopamine was the first agent of choice for 7 patients, however, norepinephrine (NE) addition was required to the treatment owing to inadequate response. 4 patients treated with dopamine had definite symptoms relevant to hyperdynamic state of septic shock. Significant improvements were noted in the values of mean arterial pressure (MAP), urinary output, cardiac index (CI), systemic vascular resistance (SVR) and oxygen delivery (DO2 ) after the treatment. Other 3 patients of dopamine group had a very low cardiac output due to myocardial expression and eventually died of severe hypotension although significant increases were established in CI and DO values after an intensive treatment.
Dopamine plus NE treatment resulted in different responses in 6 patients. Meaningful improvements were established in the MAP, urinary output, CI and SVR levels of the 2 patients with high CI values over 4 L/min/m2. However, they died of myocardial infarction and multiple organ failure (MOF) postoperatively.
No recovery was noticed in the hemodynamic parameters of the 4 patients with low CI values below 4 L/min/m2 after dopamine plus NE treatment.