EFFECT OF DEXMEDETOMIDINE ON NOREPINEPHRINE REQUIREMENTS IN CRITICALLY ILL PATIENT WITH SEPTIC SHOCK

Abstract

Septic shock is characterized by hemodynamic instability, carrying high mortality. Management follows the Surviving Sepsis Campaign guidelines, emphasizing fluid resuscitation, early vasopressor (mainly norepinephrine) use, appropriate antimicrobial therapy and other supportive measures. Norepinephrine improves vascular tone mainly and cardiac output through its α1 and β1 agonism. It is the first vasopressor line to use in hypotensive septic shock patients. Alpha-adrenergic receptors may also become desensitized and downregulated as a result of sympathetic overstimulation due to excessive catecholamines contributing to hemodynamic instability and poor outcomes. Dexmedetomidine, an α2-agonist sedative analgesic, shows promise in many fields and there is uprising role in sepsis by reducing inflammatory responses and mortality. Dexmedetomidine increases vasopressor responsiveness maintaining hemodynamics without respiratory depression. However, its side effects especially bradycardia are still a concern. AIM:To assess the effect of dexmedetomidine on norepinephrine requirements as a vasopressor in critically ill patients with septic shock.PATIENTS AND METHODS:Patients: This randomized controlled trial included 90 patients aged 18–65 years with septic shock admitted to the Critical Care Department, Alexandria University Hospitals. Informed consent from next-of-kin and approval from the Medical Ethical Committee were obtained. Inclusion Criteria: Diagnosis of septic shock according to Sepsis-3 definitions: hypotension requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation.Exclusion Criteria: Pregnant or lactating women, Patients with any form of bradycardia, Acute fulminant hepatic failure, Patients with other types of shock (e.g., cardiogenic, hypovolemic, obstructive).