Comparison of Lactic Acid and Cardiac Output Levels in the Use of Phenylephrine and Norepinephrine for Patients with Sepsis Shock at Adam Malik Haji Hospital Medan
Introduction
Sepsis and shock are serious health problems that can have devastating consequences for patients. According to the World Health Organization (WHO), sepsis is a leading cause of death worldwide, with mortality rates ranging from 20% to 50% in severe cases. In the condition of shock sepsis, lactic acid levels in the body increase, while cardiac output has decreased. These two factors become important indicators in determining the effectiveness of treatment in patients. Norepinephrine and phenylephrine are vasopressor types that can help restore the balance of high levels of lactic acid due to tissue perfusion disorders and increase cardiac output.
The Importance of Lactic Acid and Cardiac Output in Sepsis Shock
Lactic acid is a byproduct of anaerobic metabolism, and its levels can increase in the body due to tissue perfusion disorders. In the condition of shock sepsis, the body tries to maintain blood flow to vital organs, but this is often insufficient, resulting in an increase in lactic acid. Cardiac output, on the other hand, is the volume of blood pumped by the heart per minute. In sepsis shock, cardiac output can decrease due to the body's inability to maintain adequate blood flow to vital organs.
Research Methodology
This research was conducted by double-blind and random clinical test methods. The purpose of this study is to evaluate the ratio of lactic acid and cardiac output levels in patients with a sepsis shock before (T0) and after 6 hours of phenylephrine giving compared to norepinephrine at Adam Malik Hajj Hospital Medan. The research sample involved 32 patients who met the inclusion and exclusion criteria.
Research Result
The results of the study showed that the average level of lactic acid in sepsis patients before giving vasopressor therapy was 12.33 (± 4.02) mmol/l in groups that received phenylephrine and 12.11 (± 4.21) mmol/l in groups that received norepinephrine. In addition, the average cardiac output value before giving vasopressor therapy in the Phenylephrine group recorded 2.86 (± 0.67) L per minute, while the Norepinephrine group showed the number 2.65 (± 0.52) L per minute.
Conclusion
Although lactic acid levels between the two groups do not show statistically significant differences, the cardiac output value shows a significant difference. This shows that the use of phenylephrine can be more effective in increasing cardiac output compared to norepinephrine in patients with sepsis shock. This finding is important for doctors and medical personnel in determining the choice of appropriate vasopressor therapy for patients with sepsis shock, especially in Adam Malik Hospital in Medan.
Additional Analysis
Increased levels of lactic acid are a sign that the body experiences metabolic stress due to tissue perfusion disorders. In the condition of shock sepsis, the body tries to maintain blood flow to vital organs, but this is often insufficient, resulting in an increase in lactic acid. Therefore, the right choice of vasopressors is very important in patient management.
Phenylephrine as a vasopressor with the main mechanism of action in increasing vascular resistance can have a positive impact on cardiac output, which is needed in a shock sepsis condition. In practice, the decision to use one of these two drugs must be based on the patient's overall clinical condition, and not only based on lactic acid levels or cardiac output.
Implications for Clinical Practice
This study provides important insights for clinical practices and emphasizes the need for further research to explore the mechanisms and effectiveness of various vasopressors in dealing with sepsis shock. The findings of this study suggest that phenylephrine may be a more effective option for increasing cardiac output in patients with sepsis shock compared to norepinephrine. However, further research is needed to confirm these findings and to explore the potential benefits and risks of using phenylephrine in this context.
Limitations of the Study
This study has several limitations that should be considered when interpreting the results. The sample size was relatively small, and the study was conducted in a single hospital setting. Additionally, the study only evaluated the effects of phenylephrine and norepinephrine on lactic acid and cardiac output levels, and did not explore other potential outcomes, such as mortality or morbidity.
Future Directions
Future studies should aim to confirm the findings of this study and to explore the potential benefits and risks of using phenylephrine in patients with sepsis shock. Additionally, studies should aim to evaluate the effects of other vasopressors on lactic acid and cardiac output levels in patients with sepsis shock. This will provide a more comprehensive understanding of the mechanisms and effectiveness of various vasopressors in dealing with sepsis shock.
Conclusion
In conclusion, this study provides important insights for clinical practices and emphasizes the need for further research to explore the mechanisms and effectiveness of various vasopressors in dealing with sepsis shock. The findings of this study suggest that phenylephrine may be a more effective option for increasing cardiac output in patients with sepsis shock compared to norepinephrine. However, further research is needed to confirm these findings and to explore the potential benefits and risks of using phenylephrine in this context.Frequently Asked Questions (FAQs) about the Comparison of Lactic Acid and Cardiac Output Levels in the Use of Phenylephrine and Norepinephrine for Patients with Sepsis Shock
Q: What is sepsis shock, and how common is it?
A: Sepsis shock is a life-threatening condition that occurs when the body's response to an infection becomes uncontrolled and causes widespread inflammation. It is a leading cause of death worldwide, with mortality rates ranging from 20% to 50% in severe cases.
Q: What are lactic acid and cardiac output, and why are they important in sepsis shock?
A: Lactic acid is a byproduct of anaerobic metabolism, and its levels can increase in the body due to tissue perfusion disorders. Cardiac output, on the other hand, is the volume of blood pumped by the heart per minute. In sepsis shock, lactic acid levels can increase, and cardiac output can decrease due to the body's inability to maintain adequate blood flow to vital organs.
Q: What are phenylephrine and norepinephrine, and how do they work in sepsis shock?
A: Phenylephrine and norepinephrine are vasopressor types that can help restore the balance of high levels of lactic acid due to tissue perfusion disorders and increase cardiac output. Phenylephrine works by increasing vascular resistance, while norepinephrine works by increasing both vascular resistance and cardiac output.
Q: What were the results of the study comparing phenylephrine and norepinephrine in sepsis shock?
A: The study found that the average level of lactic acid in sepsis patients before giving vasopressor therapy was similar in both groups, but the cardiac output value showed a significant difference. The phenylephrine group had a higher cardiac output value compared to the norepinephrine group.
Q: What are the implications of the study for clinical practice?
A: The study suggests that phenylephrine may be a more effective option for increasing cardiac output in patients with sepsis shock compared to norepinephrine. However, further research is needed to confirm these findings and to explore the potential benefits and risks of using phenylephrine in this context.
Q: What are the limitations of the study?
A: The study has several limitations, including a small sample size and a single hospital setting. Additionally, the study only evaluated the effects of phenylephrine and norepinephrine on lactic acid and cardiac output levels, and did not explore other potential outcomes, such as mortality or morbidity.
Q: What are the future directions for research in this area?
A: Future studies should aim to confirm the findings of this study and to explore the potential benefits and risks of using phenylephrine in patients with sepsis shock. Additionally, studies should aim to evaluate the effects of other vasopressors on lactic acid and cardiac output levels in patients with sepsis shock.
Q: What are the potential benefits and risks of using phenylephrine in sepsis shock?
A: The potential benefits of using phenylephrine in sepsis shock include increased cardiac output and improved blood flow to vital organs. However, the potential risks include increased blood pressure and cardiac workload, which can lead to cardiac complications.
Q: What are the potential benefits and risks of using norepinephrine in sepsis shock?
A: The potential benefits of using norepinephrine in sepsis shock include increased cardiac output and improved blood flow to vital organs. However, the potential risks include increased blood pressure and cardiac workload, which can lead to cardiac complications.
Q: How can healthcare providers make informed decisions about the use of phenylephrine and norepinephrine in sepsis shock?
A: Healthcare providers should consider the patient's overall clinical condition, including their hemodynamic status, cardiac function, and respiratory status, when making decisions about the use of phenylephrine and norepinephrine in sepsis shock. They should also consider the potential benefits and risks of each medication and monitor the patient's response to treatment closely.