OBJECTIVE: To determine whether there was a difference between epinephrine and norepinephrine in achieving a mean arterial pressure (MAP) goal in intensive care (ICU) patients. DESIGN: Prospective, double-blind, randomised-controlled trial. SETTING:Four Australian university-affiliated multidisciplinary ICUs. PATIENTS AND PARTICIPANTS: Patients who required vasopressors for any cause at randomisation. Patients with septic shock and acute circulatory failure were analysed separately. INTERVENTIONS: Blinded infusions of epinephrine or norepinephrine to achieve a MAP >or=70 mmHg for the duration of ICU admission. MEASUREMENTS: Primary outcome was achievement of MAP goal >24 h without vasopressors. Secondary outcomes were 28 and 90-day mortality. Two hundred and eighty patients were randomised to receive either epinephrine or norepinephrine. Median time to achieve the MAP goal was 35.1 h (interquartile range (IQR) 13.8-70.4 h) with epinephrine compared to 40.0 h (IQR 14.5-120 h) with norepinephrine (relative risk (RR) 0.88; 95% confidence interval (CI) 0.69-1.12; P = 0.26). There was no difference in the time to achieve MAP goals in the subgroups of patients with severe sepsis (n = 158; RR 0.81; 95% CI 0.59-1.12; P = 0.18) or those with acute circulatory failure (n = 192; RR 0.89; 95% CI 0.62-1.27; P = 0.49) between epinephrine and norepinephrine. Epinephrine was associated with the development of significant but transient metabolic effects that prompted the withdrawal of 18/139 (12.9%) patients from the study by attending clinicians. There was no difference in 28 and 90-day mortality. CONCLUSIONS: Despite the development of potential drug-related effects with epinephrine, there was no difference in the achievement of a MAP goal between epinephrine and norepinephrine in a heterogenous population of ICU patients.
RCT Entities:
OBJECTIVE: To determine whether there was a difference between epinephrine and norepinephrine in achieving a mean arterial pressure (MAP) goal in intensive care (ICU) patients. DESIGN: Prospective, double-blind, randomised-controlled trial. SETTING: Four Australian university-affiliated multidisciplinary ICUs. PATIENTS AND PARTICIPANTS: Patients who required vasopressors for any cause at randomisation. Patients with septic shock and acute circulatory failure were analysed separately. INTERVENTIONS: Blinded infusions of epinephrine or norepinephrine to achieve a MAP >or=70 mmHg for the duration of ICU admission. MEASUREMENTS: Primary outcome was achievement of MAP goal >24 h without vasopressors. Secondary outcomes were 28 and 90-day mortality. Two hundred and eighty patients were randomised to receive either epinephrine or norepinephrine. Median time to achieve the MAP goal was 35.1 h (interquartile range (IQR) 13.8-70.4 h) with epinephrine compared to 40.0 h (IQR 14.5-120 h) with norepinephrine (relative risk (RR) 0.88; 95% confidence interval (CI) 0.69-1.12; P = 0.26). There was no difference in the time to achieve MAP goals in the subgroups of patients with severe sepsis (n = 158; RR 0.81; 95% CI 0.59-1.12; P = 0.18) or those with acute circulatory failure (n = 192; RR 0.89; 95% CI 0.62-1.27; P = 0.49) between epinephrine and norepinephrine. Epinephrine was associated with the development of significant but transient metabolic effects that prompted the withdrawal of 18/139 (12.9%) patients from the study by attending clinicians. There was no difference in 28 and 90-day mortality. CONCLUSIONS: Despite the development of potential drug-related effects with epinephrine, there was no difference in the achievement of a MAP goal between epinephrine and norepinephrine in a heterogenous population of ICU patients.
Authors: N P Day; N H Phu; N T Mai; D B Bethell; T T Chau; P P Loc; L V Chuong; D X Sinh; T Solomon; G Haywood; T T Hien; N J White Journal: Crit Care Med Date: 2000-05 Impact factor: 7.598
Authors: J L Vincent; A de Mendonça; F Cantraine; R Moreno; J Takala; P M Suter; C L Sprung; F Colardyn; S Blecher Journal: Crit Care Med Date: 1998-11 Impact factor: 7.598
Authors: Daniel De Backer; Maurizio Cecconi; Jeffrey Lipman; Flavia Machado; Sheila Nainan Myatra; Marlies Ostermann; Anders Perner; Jean-Louis Teboul; Jean-Louis Vincent; Keith R Walley Journal: Intensive Care Med Date: 2019-02-11 Impact factor: 17.440
Authors: Alistair D Nichol; Moritoki Egi; Ville Pettila; Rinaldo Bellomo; Craig French; Graeme Hart; Andrew Davies; Edward Stachowski; Michael C Reade; Michael Bailey; David James Cooper Journal: Crit Care Date: 2010-02-24 Impact factor: 9.097