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Restoring arterial pressure with norepinephrine improves muscle tissue oxygenation assessed by near-infrared spectroscopy in severely hypotensive septic patients

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Abstract

Purpose

To examine the consequences of administration of norepinephrine on muscle tissue oxygenation in severely hypotensive septic shock patients.

Methods

This was a prospective observational study conducted in a medical intensive care unit of a university hospital. We included 28 septic shock patients that received early volume resuscitation. All were eligible for receiving norepinephrine because of life-threatening hypotension and low diastolic arterial pressure. Muscle tissue oxygen saturation (StO2) and its changes during a vascular occlusion test were measured at the level of the thenar eminence using a near-infrared spectroscopy (NIRS) device. Transpulmonary thermodilution cardiac index (CI) and NIRS-derived variables were obtained before and after the mean arterial pressure (MAP) was increased by norepinephrine. The baseline StO2 and the vascular occlusion test-derived variables of 17 healthy volunteers were measured and served as controls.

Results

In healthy volunteers, StO2 ranged between 75 and 90% and StO2 recovery slopes ranged between 1.5 and 3.4%/s. Administration of norepinephrine, which was associated with an increase in MAP from 54 ± 8 to 77 ± 9 mmHg (p < 0.05), also induced increases in CI from 3.14 ± 1.03 to 3.61 ± 1.28 L/min/m2 (p < 0.05), in StO2 from 75 ± 9 to 78 ± 9% (p < 0.05) and in StO2 recovery slope from 1.0 ± 0.6 to 1.5 ± 0.7%/s (p < 0.05).

Conclusions

Norepinephrine administration aimed at achieving a MAP higher than 65 mmHg in septic shock patients with life-threatening hypotension resulted in improvement of NIRS variables measured at the level of the thenar eminence.

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Authors and Affiliations

  1. Service de réanimation médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris Sud, 78, rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France

    Jean-François Georger, Olfa Hamzaoui, Anis Chaari, Julien Maizel, Christian Richard & Jean-Louis Teboul

Authors
  1. Jean-François Georger
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  2. Olfa Hamzaoui
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  3. Anis Chaari
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  4. Julien Maizel
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  5. Christian Richard
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  6. Jean-Louis Teboul
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Correspondence to Jean-Louis Teboul.

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Jean-Louis Teboul is a member of the medical advisory board of Pulsion.

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Georger, JF., Hamzaoui, O., Chaari, A. et al. Restoring arterial pressure with norepinephrine improves muscle tissue oxygenation assessed by near-infrared spectroscopy in severely hypotensive septic patients. Intensive Care Med 36, 1882–1889 (2010). https://doi.org/10.1007/s00134-010-2013-3

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  • DOI: https://doi.org/10.1007/s00134-010-2013-3

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