The efficacy of combination of Terlipressin and Norepinephrine Versus Norepinephrine in Septic Shock

Introduction: Sepsis is the clinical syndrome defined by the presence of systemic inflammatory 
response syndrome (SIRS) in the setting of an infection. Aim of the work: Aim of this study is to 
evaluate and compare the effect of terlipressin and norepinephrine versus norepinephrine in septic 
shock. Patients and methods: After obtaining the local ethics committee of EL-Minia University 
Hospital . approval and written informed consent was taken from the relatives, this prospective double 
blind study was conducted on 40 adult patients of both gender admitted to our ICU with septic shock. 
Septic shock was defined by the presence of two or more diagnostic criteria for systemic 
inflammatory response syndrome, proven or suspected Infection, and hypotension despite adequate 
fluid resuscitation (defined as systolic blood pressure <90 mmHg or MAP <70 mmHg in absence of 
other causes of hypotension. The patients were allocated into two equal groups (20 patients in each 
group) by using a computer- generated table. Group A (Norepinephrine group): Two syringe 
pumps were prepared one containing NE (8mg) was dissolved in a 50ml syringe containing 5% 
dextrose in water and the other containing saline. The NE infusion started at .05ug/kg/min (at rate 
1.3ml/hr) with maxium infusion rate of 0.8ug/kg/min till reached the target mean arterial blood 
pressure of 65-75mmHg. Group B (Terlipressin plus NE): Two syringe pumps were prepared
terlipressin (1mg) was dissolved in a 50ml syringe containing 5% dextrose in water. And NE (8mg) 
was dissolved in a 50ml syringe containing 5% dextrose in water. Terlipressin infusion started at 20-
160ug/h (at rate1ml/hr) with maximum infusion rate of 4mg/day) in addition to norepinephrine 
whereas the NE infusion started at .05ug/kg/min which uptitrated if the target mean arterial pressure 
not reached after maximum dose of terlipressin. Results: Combination of terlipressin with 
norepinephrine improve hemodynamics, renal function, lactate clearance, reduce norepinephrine
requirement.