Aim: To evaluate the effect of noradrenaline infusion in a case of hyperdynamic septic shock refractory to volume loading, dopamine and dobutamine, on hemodynamic parameters, oxygen transport, lactate and pyruvate levels.
Design: Description of a clinical case.
Setting: Postsurgical Intensive Care Unit in a University Hospital.
Patient: A 48-year-old woman with symptoms of peritonitis due to Enterobacter Agglomerans and refractory hyperdynamic septic shock.
Interventions: Administration of noradrenaline in doses ranging from 0.03 to 0.14 micrograms/kg/min.
Measurements and results: Before and after noradrenaline infusion the following were evaluated: hemodynamic (parameters) and oxygen transport acid-base status, arterial blood levels of lactate and pyruvate, and lactate/pyruvate ratio. During the administration of noradrenaline an increase was observed over time in oxygen consumption (from 110 +/- 16 to 164 +/- 19 mL/min/m2; p < 0.01), peripheral vascular resistance (from 509 +/- 95 to 1172 +/- 384 dynes.sec.cm-5, p < 0.01) and the oxygen extraction index (from 12.9 +/- 2.1 to 21.2 +/- 2.9%, p < 0.01), together with reduced lactate (from 24.4 +/- 1.5 to 4.9 +/- 5.1 mmol/L) and pyruvate levels (from 945 +/- 62 to 357 +/- 174 mumol/L; p < 0.01) and a reduced lactate/pyruvate ratio (from 26.2 +/- 1.2 to 11.8 +/- 5.9, p < 0.01). No significant increases were found in cardiac output and oxygen delivery.
Conclusions: In the case observed here the infusion of noradrenaline induced an increase in oxygen consumption and the oxygen extraction index associated with a reduction in the lactate/pyruvate ratio and the normalisation of the acid-base status. These changes were not associated with an increase in oxygen which remained delivery > or = 600 mL/min/m2.