Norepinephrine supplemented with dobutamine or epinephrine for the cardiovascular support of patients with septic shock

Background and Aims:

Sepsis management remains a great challenge for intensive care medicine. The aim of this study was to evaluate the effect of adding dobutamine versus epinephrine to norepinephrine in treating septic shock patients refractory to fluid therapy.

Materials and Methods:

Sixty adult patients with the diagnosis of septic shock were included in this study. Norepinephrine infusion was started at a dose of 0.05 μg/kg/min, and increased gradually up to 0.1 μg/kg/min. Upon reaching this dose, patients with mean arterial pressure <70 mmHg were further divided randomly into two equal groups. In group I: the patients continued on norepinephrine and dobutamine was added at a starting dose of 3 μg/kg/min and increased in increments of 2 μg/kg/min up to 20 μg/kg/min. In group II: the patients continued on norepinephrine and epinephrine was added in a starting dose of 0.05 μg/kg/ min and increased in increments of 0.03 μg/kg/min up to 0.3 μg/kg/min.

Results:

Group II patients developed significantly better cardiovascular parameters, lower arterial pH and higher serum lactate and urine output; however, the 28-day mortality and major adverse effects were comparable in both groups.

Conclusions:

The addition of epinephrine to norepinephrine has positive effects on the cardiovascular parameters but negative results on the serum lactate concentration and systemic pH compared with the addition of dobutamine to norepinephrine.

Senses, bodily knowledge, and autoethnography: unbeknown knowledge from an ICU experience

In this article, I discuss the possibilities and limits of bodily knowledge for research. The text is based on my personal experiences as a patient in an intensive care unit (ICU). It seems that through my senses I unconsciously gained knowledge of the time I spent in the ICU. To describe this specific form of bodily knowledge, I introduce the concept of "unbeknown" knowledge, and suggest that autoethnography is a useful method for analyzing this knowledge. In conclusion, I maintain that there is a certain hierarchy for both senses and knowledge and, in spite of the possible vagueness and fuzziness of the concept, unbeknown knowledge both enhances recovery and can be used for research purposes.