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and Norepinephrine
in the Treatment of Shock
1. The administration of
SHOCK
fluids
3. adrenergic agents
Norepinephrine
increase vascular tone
adrenergik
decrease cardiac
output and regional
blood flow, especially in
cutaneous, splanchnic,
and renal beds.
Agen adrenergik
maintain blood flow
through inotropic and
chronotropic effects
increase splanchnic
adrenergik
perfusion
Increase cellular
metabolism and
immunosuppressive
effects
Dopamine also stimulates dopaminergic receptors, resulting in a
proportionately greater increase in splanchnic and renal perfusion,
and it may facilitate resolution of lung edema.
Objective
The primary end point of the trial was the rate of death at 28 days.
the duration of stay in the ICU; the number of days without need for
organ support (i.e., vasopressors, ventilators, or renal replacement
therapy)
the time to attainment of hemodynamic stability
Measures Variabel
The following data were recorded every 6 hours for 48 hours, every 8 hours on
days 3, 4, and 5, and once a day on days 6, 7, 14, 21, and 28:
Vital signs
hemodynamic variables (including systolic and diastolic arterial pressures, heart rate,
central venous pressure, and, when possible, pulmonary- artery pressures), cardiac
output, arterial and mixed-venous (or central venous) blood gas levels
doses of vasoactive agents
respiratory conditions
Biologic variables
data on daily fluid balance
microbiologic data
antibiotic therapy were recorded daily for the first 7 days and then on days 14, 21, and
28.
Statistical Analysis
Among patients with cardiogenic shock, the rate of death was significantly
higher in the group treated with dopamine than in the group treated with
norepinephrine, although one might expect that cardiac output would be better
maintained with dopamine than with norepinephrine, but the early difference in
the rate of death suggests that the higher heart rate with dopamine may have
contributed to the occurrence of ischemic events.
Kesimpulan