Phenylephrine septic

Despite its purported use in refractory septic shock, very little information is published regarding the clinical efficacy of phenylephrine. Nevertheless, it is an attractive agent for use in sepsis owing to its selective a-agonism and primarily vascular effects and its rapid onset < and short duration of action. It is generally initiated at dosages of 0.5 mcg/kg per minute and may be titrated quickly to desired effect. 

There are three clinical trials using phenylephrine in septic shock evaluating 38 patients. Phenylephrine (0.5 to 9 mcg/kg per minute), when used alone or in combination with dobutamine or low doses of dopamine, improves blood pressure and myocardial performance in fluid-resuscitated septic patients. Incremental doses of phenylephrine over 3 hours result in linear dose-related increases in MAP, SVR, heart rate, and stroke index when administered as a single agent in stable, nonhypotensive but hyperdynamic, volume-resuscitated... 

Elancbaum L, Dick M, Dasta J, et al. A dose-response study of phenylephrine in critically ill, septic surgical patients. EurJ CUn Pharmacol 1997 5L461-465. 

Gregory JS, Bonflglio ME, Dasta JE, et al. Experience with phenylephrine as a component of the pharmacologic support of septic shock. Crit Care Med 1991 19 1395-1400. 

Bellissant E, Annane D. Effect of hydrocortisone on phenylephrine Mean arterial pressure dose-response relationship in septic shock. Clin Pharmacol Ther 2000 68 293-303. 

Phenylephrine, a selective a i-agonist, has a rapid onset, short duration, and primary vascular effects, making it an attractive agent in the management of hypotension associated with septic shock. The limited available information suggests that it can increase blood pressure in fluid-resuscitated patients, and it does not appear to impair cardiac or renal function. Phenylephrine appears useful when tachycardia limits the use of other vasopressors. 

---