The Role of Norepinephrine in Septic Shock Patients  

Oleh:

Guntur H.A.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Dexa Media vol. 21 no. 1 (Jan. 2008), page 3-9.
Topik: Sepsis; Septic Shock; Vasopressor
Fulltext: D04 v21 p3 kelik2018.pdf (398.62KB)

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Perpustakaan FK Nomor Panggil: D04.K Non-tandon: 2 (dapat dipinjam: 0) Tandon: tidak ada

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Sepsis is a clinical syndrome as an overactive body response to microorganismal product stimuli. Manifestations of fever, tachycardia, tachypneu, hypotension and organ malfunction are related with the cardiovascular problem level. The sepsis clinical signs is hyperthermia/hypothermia (>38,3C; <35,6C), tachypneu (respiratory rate >20/minute), tachycardia (pulse >100/minute), leukocytosis (>12.000/mm3) or leukopenia (>4.000/mm3, immature cell (10%), suspected infection, and biomarker sign : PcT, CrP (ccm 2003)). Septic shock as a subset, septic shock is difined as septic-induced hypotension which is permanent even after fluid resuscitation, with tissue hypoperfusion. The septic shock clinical signs are early phase signs (e.g volume depletion, dry mucosal layer, dry and humid skin), post fluid resuscitation signs (hyperdinamic shock, e.g tachycardia, hard and wide arterial pulse, palpatory hyperdynamic precordium and warm extremities) associated with sepsis manifestations and hipoperfusion signs (e.g tachypneu, oliguria, cyanosis, mottling, ischemic finger, mental change). In accordance with EGDT (Early Goal Directed Therapy) protocol, the early management covers by giving crystalloid colloid fluid replacements. The unresponsive patients to this fluid replacement, then, should be treated with vasoactive drugs. There is still debateful in determining the best vasoactive drugs used in septic shock. The main therapeutical target is the recovery of tissue perfusion by increasing the Mean Arterial Pressure (MAP) to 65 till 75 mmHg. The other needed target is myocardial contractility increase if it is appropriate and good tissue oxygen supply. Vasoconstrictors is strong enough to produce SVR and blood pressure increase without having at all effect on increasing arterial pulse, MAP increase at 65-75 mmHg, at the used dose of 47 ug/minute, maintaining the heart rate of 97-101/minute. norepinephrine is still potential for alpha-1 receptor agonist first choice management in septic shock.

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