Less is more: catecholamine-sparing strategies in septic shock

  • Balasubramanian VenkateshEmail author
  • Ashish K. Khanna
  • Jeremy Cohen
Less is more in Intensive Care

Noradrenaline, a catecholamine, is the first line agent for the management of septic shock [1] and has been shown to be superior to dopamine [2] and equivalent to adrenaline [3] and vasopressin [4]. High doses of catecholamines are frequently required to reverse shock [5, 6]. While the presence of circulatory shock remains a strong and independent predictor of mortality [7], the use of catecholaminergic agents to reverse shock is associated with adverse events—tachyarrhythmias, thermogenic, metabolic and excess vasoconstriction resulting in tissue ischemia [2, 8]. These adverse effects have led to an interest in adjunctive therapies and catecholamine minimization strategies.

Optimal fluid resuscitation

The first step is optimizing fluid resuscitation. While guidelines recommend optimal filling prior to initiation of vasopressor support [1], the precise endpoints for fluid resuscitation remain unclear. In resource-limited settings in Africa, fluid boluses significantly increased 48-h...



Prof. Venkatesh is supported by an NHMRC-Medical Research Future Fund Practitioner Fellowship. This work was also supported by an NHMRC grant APP1161182.

Compliance with ethical standards

Conflicts of interest

The authors do not have any financial conflict of interest in association with this manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Balasubramanian Venkatesh
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  • Ashish K. Khanna
    • 6
  • Jeremy Cohen
    • 1
    • 3
    • 5
    • 7
  1. 1.The Wesley HospitalBrisbaneAustralia
  2. 2.Princess Alexandra HospitalBrisbaneAustralia
  3. 3.University of QueenslandBrisbaneAustralia
  4. 4.University of New South WalesSydneyAustralia
  5. 5.The George Institute for Global HealthSydneyAustralia
  6. 6.Department of Anesthesiology, Section On Critical Care Medicine, Wake Forest School of MedicineWake Forest Baptist HealthWinston-SalemUSA
  7. 7.The Royal Brisbane and Women’s HospitalHerstonAustralia

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