ArticleChest2022
Comparison of Heart Rate After Phenylephrine vs Norepinephrine Initiation in Patients With Septic Shock and Atrial Fibrillation.
Article in Chest, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Early management of adult sepsis and septic shock: Korean clinical practice guidelines.Acute and critical care · 2024Guideline
- Maximum heart rate and mortality in sepsis patients: a retrospective cohort study.Internal and emergency medicine · 2026Article
- Resuscitation Targets, Fluids, and Vasoactives in Septic Shock.Clinics in chest medicine · 2026Review
- Perioperative Vasopressor Management in Noncardiac Surgical Patients.Anesthesiology · 2026Article
- Influencing Factors of New-Onset Atrial Fibrillation in Sepsis Patients and Construction of a Nomogram Prediction Model: Based on LASSO Regression.International journal of general medicine · 2026Article
- Sepsis-induced Atrial Fibrillation: Can We Predict and Prevent This High-Risk Complication?Cureus · 2025Review
- Atrial fibrillation in critical illness: state of the art.Intensive care medicine · 2025Review
- The Anrep effect in septic shock: a mechanism of cardiac adaptation.British journal of anaesthesia · 2025Article
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- Analysis of the effects of early screening combined with blood lactate on the severity of patients with sepsis.Heliyon · 2024Article
- Article
- Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades?Microorganisms · 2023Review
- Norepinephrine combined with phenylephrine versus norepinephrine in patients with septic shock: a retrospective cohort study.BMC infectious diseases · 2023Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundAtrial fibrillation (AF) is a common complication of sepsis. It is unclear whether norepinephrine, an α- and β-agonist, and phenylephrine, an α-agonist, are associated with different heart rates among patients with sepsis and AF. RESEARCH QUESTION: Among patients with sepsis and AF, what is the difference in heart rate after phenylephrine initiation vs norepinephrine initiation? STUDY DESIGN AND
methodsWith the use of an extensive database, we identified patients with sepsis and AF at the time of norepinephrine or phenylephrine initiation. We estimated the difference in heart rate between patients who received phenylephrine or norepinephrine 1 and 6 h after vasopressor initiation with the use of multivariable-adjusted linear regression, tested for effect modification by heart rate, and stratified by baseline heart rate ≥ 110 or < 110 beats/min. Secondary outcomes included conversion to sinus rhythm, bradycardia, vasopressor duration, ICU and hospital length of stay, and hospital death. Exploratory analyses were adjusted for practices that occurred after vasopressor initiation; sensitivity analyses used interrupted time series to estimate the difference in average heart rate between patients who received phenylephrine or norepinephrine.
resultsAmong 1847 patients with sepsis and AF, 946 patients (51%) received norepinephrine, and 901 patients (49%) received phenylephrine. After multivariable adjustment, phenylephrine was associated with a lower heart rate at 1 h (-4 beats/min; 95% CI, -6 to -1; P < .001) and 6 h (-4 beats/min; 95% CI, -6 to -1; P = .004). Higher heart rate before vasopressor administration was associated with larger heart rate reduction in patients who received phenylephrine compared with norepinephrine. There were no differences in secondary outcomes. Results were similar in exploratory and sensitivity analyses.
interpretationIn patients with sepsis and AF, the initiation of phenylephrine was associated with modestly lower heart rate compared with norepinephrine. Heart rate at vasopressor initiation appeared to be an important effect modifier. Whether modest reductions in heart rate are associated with clinical outcomes requires further study.
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