J.Jpn. Surg. Soc.. 90(2): 181-186, 1989

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Original article

HEMODYNAMIC CHANGES ON THE COURSE OF SEPTIC MULTIORGAN FAILURE PATIENTS

The hemodynamic changes on the course of septic multiorgan failure (s-MOF), and the effects of norepinephrine administrated at septic shock state were evaluated in thirteen patients who died of s-MOF in ICU. The course in ICU was divided into following three stages. Stage I was for a few days after admission in ICU. Stage II was severe infected state. Stage III was the terminal state, i.e., a few days before death.
Norepinephrine was administrated when conventional catecholamines (dopamine and/or dobutamine) could not maintain the blood pressure level in the shift from stage II to III, and the hemodynamic changes were evaluated before and after the administration.
The following results were obtained:
1) Hemodynamic changes: The stage I was characterized as a moderately hyperdynamic state. The stage II exhibited a typical hyperdynamic state distinguished by a decrease in systemic vascular resistance (SVR). The stage III was distinguished as a normodynamic shock state, because of fall of cardiac output within normal control level.
2) Norepinephrine increased cardiac index, heart rate, and right ventricular stroke work index, but mean arterial pressure, stroke index and SVR did not exhibit any change. However, norepinephrine was useful aid to maintain the circulation in hypotensive state, when conventional catecholamines could not maintain blood pressure any more.

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