Am. J. Respir. Crit. Care Med., Volume 159, Number 4, April 1999, 1186-1192

Effects of Norepinephrine on the Renal Vasculature in Normal and Endotoxemic Dogs

RINALDO BELLOMO, JOHN A. KELLUM, STEPHEN R. WISNIEWSKI, MICHAEL R. PINSKY, and Brian Ondulik

Cardiopulmonary Research Laboratory, Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh Medical Center; and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

Septic shock is often complicated by systemic hypotension despite normal or increased cardiac output. Restoration of arterial pressure usually requires the administration of systemic vasopressor agents, such as norepinephrine. However, because norepinephrine induces vasoconstriction in other vascular beds, it may decrease visceral blood flow, impairing visceral organ function. Because sepsis is often associated with impaired peripheral vascular responsiveness, we hypothesized that, unlike in normal circulatory conditions, norepinephrine would improve visceral organ blood flow in sepsis by selectively increasing organ perfusion pressure. Thus, in nine pentobarbital-anesthetized, mechanically ventilated dogs, we measured the effect of norepinephrine infusion (0.3 µg/kg/min) on renal, hepatic, and portal steady-state pressure-flow relations (P/) and the dynamic vascular P/, created by transient inferior vena caval occlusion, under basal and endotoxic conditions. Norepinephrine increased organ perfusion pressures during both control and endotoxemic conditions. However, even after controlling for the pressure effect using a general linear model, NE was associated with an increase in renal blood flow both before and after endotoxin administration. We conclude that, unlike the effects of administering norepinephrine under baseline conditions, norepinephrine infusion during endotoxic shock actually increases renal blood flow and that this effect is not the result of an increase in perfusion pressure alone.

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