A higher mean arterial pressure (MAP) achieved by
norepinephrine up-titration may improve organ blood flow in
critically ill, whereas
norepinephrine-induced afterload rise might worsen myocardial function. Our aim was to assess the effects of
norepinephrine dose titration on global hemodynamics in
cardiogenic shock. We prospectively evaluated 12 mechanically ventilated euvolemic patients (aged 67 +/- 12 years) in
cardiogenic shock (10 patients acute
myocardial infarction, 1 patient
dilated cardiomyopathy, 1 patient decompensated
aortic stenosis). Hemodynamic monitoring included arterial and Swan-Ganz
catheters. The first data were obtained at MAP of 65 mm Hg, then the
norepinephrine dose was increased over 40 min to achieve MAP of 85 mm Hg. Finally, the
norepinephrine-dose was tapered over 40 min to achieve MAP of 65 mm Hg.
Norepinephrine up-titration increased MAP to the predefined values in all patients with concomitant mild increase in filling pressures and heart rate. Systemic vascular resistance increased, whereas cardiac output remained unchanged. During
norepinephrine down-titration, all hemodynamic parameters returned to baseline values. We observed no changes in
lactate levels and mixed venous oxygen saturation. Our data suggest that short-term
norepinephrine dose up-titration in
cardiogenic shock patients treated or pretreated with inotropes was tolerated well by the diseased heart.