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Abstract
Despite numerous advances in medication, sepsis remains an unconquered challenge. Although outcomes have improved slightly over decades, the unacceptability high mortality for sepsis and septic shock continues. Sepsis and consequent multi-organ failure syndrome are responsible for over 60% of deaths in patients receiving critical care The aim of this study is to evaluate the effect of adding dobutamine versus epinephrine to norepinephrine in treating septic shock patients refractory to fluid therapy This study was carried out in intensive care unit, Menoufyia university hospital after a written informed consent. Forty adult patients with the diagnosis of septic shock were included in this study (temperature 38 or 36 degrees Celsius, heart rate 90 beats/min, mean arterial blood pressure 70mmHg in spite of adequate fluid therapy, respiratory rate 20 breaths/min, leucocytic count 12,000 cells/mm3 or 4,000 cells/mm3 and blood lactate concentration 2 mEq/L).
The patients known with the following diseases (cardiac diseases as ischemic heart, cardiomyopathy, severe renal or hepatic impairment, peripheral vascular diseases as diabetic foot, Burger’s disease or peripheral occlusive disease coagulopathy diseases and burns) were excluded from this study All patients were scored by sepsis- related organ failure score( SOFA score) and monitored by (ECG, CVP, invasive blood pressure monitoring , ABG sampling and echocardiography All patients received traditional treatment of sepsis (fluids, antibiotics, glucose control and respiratory support) and the fluid therapy in the form of Crystalloid fluid which was administered till achieving a normal CVP. In patients who were still hypotensive, norepinephrine infusion was started at a dose of 50 ng/kg/min and the dose was increased gradually up to 100 ng/kg/min. After reaching this dose, patients with (MAP 70 mmHg) were further divided randomly into two groups, 20 patients each.