The Effects of Short-Term Norepinephrine Up-Titration on Hemodynamics in Cardiogenic Shock

A higher mean arterial pressure (MAP) achieved bynorepinephrine up-titration may improve organ blood flow incritically ill, whereas norepinephrine-induced afterload rise mightworsen myocardial function. Our aim was to assess the effects ofnorepinephrine dose titration on global hemodynamics incardiogenic shock. We prospectively evaluated 12 mechanicallyventilated euvolemic patients (aged 67±12 years) in cardiogenicshock (10 patients acute myocardial infarction, 1 patient dilatedcardiomyopathy, 1 patient decompensated aortic stenosis).Hemodynamic monitoring included arterial and Swan-Ganzcatheters. The first data were obtained at MAP of 65 mm Hg,then the norepinephrine dose was increased over 40 min toachieve MAP of 85 mm Hg. Finally, the norepinephrine-dose wastapered over 40 min to achieve MAP of 65 mm Hg.Norepinephrine up-titration increased MAP to the predefinedvalues in all patients with concomitant mild increase in fillingpressures and heart rate. Systemic vascular resistance increased,whereas cardiac output remained unchanged. Duringnorepinephrine down-titration, all hemodynamic parametersreturned to baseline values. We observed no changes in lactatelevels and mixed venous oxygen saturation. Our data suggestthat short-term norepinephrine dose up-titration in cardiogenicshock patients treated or pretreated with inotropes was toleratedwell by the diseased heart.