Catecholamines in the treatment of septic shock: effects beyond perfusion.

OBJECTIVE To review the metabolic effects of sympathomimetic agents in the septic patient. DATA SOURCES A review of articles reported on the metabolic effects of the commonly used sympatho-mimetic agents in the critically ill patient. SUMMARY OF REVIEW Sepsis and septic shock are clinically charcterized mainly by derangements of cardiocirculatory function. Mainstay therapeutic interventions for haemodynamic stabilisation are adequate volume resuscitation and vasoactive agents. These, however, may be linked with additional effects on energy balance and cell metabolism. As well as the haemodynamic effects, specific metabolic effects need to be considered for optimal vasopressor treatment during severe sepsis and septic shock. This review highlights the typical haemodynamic and metabolic alterations associated with the commonly used sympathomimetic drugs in these conditions. CONCLUSIONS Sepsis and septic shock are linked with profound metabolic alterations. An additional impact of vasoactive therapy on metabolism has to be taken into account when using these agents to treat severe sepsis and septic shock.