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Correspondence
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Volume 341:56-57 July 1, 1999 Number 1
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Treating Patients with Severe Sepsis

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by Wheeler, A. P.
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To the Editor: Drs. Wheeler and Bernard (Jan. 21 issue)1 provide an informative overview of the treatment of patients with severe sepsis. Their comments on the use of catecholamines for severe sepsis, especially as listed in Table 2, seem to reflect the effects observed under physiologic (nonseptic) conditions. In patients with sepsis, catecholamines may have different effects. Epinephrine decreases splanchnic blood flow, gastric mucosal pH, and splanchnic oxygen consumption and increases blood lactate concentrations in patients with sepsis.2,3 A group of specialists in sepsis has concluded that epinephrine should be avoided in the treatment of septic shock, leaving norepinephrine as . . . [Full Text of this Article]

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