Naloxone in septic shock

[LACoGurneyjockey]

Another thread here got me reading on the use of narcan in septic shock patients. There's several studies suggesting it raises the BP significantly, but having no real improvement in survival rates. The only mechanism I can find is the endorphins released in septic shock in part causing the hypotension are blocked by the narcan, thus marginally raising the pressure.
Just interested if anyone has any experience with narcan in septic shock? Or even better, a protocol for it? Everywhere I've found it mentions it as a last line in hypotensive septic shock unresponsive to fluids and pressors.

Also, I can't find anything further on the mechanism. They say narcan blocks the endorphins released in septic shock. But why/how are these endorphins being released?
Really just got me thinking on it, now I'm just craving more info on it. Any input is welcome.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625808/

http://enotes.tripod.com/septicshock.htm

http://www.drugs.com/pro/narcan.html

 

[Carlos Danger]

I've never heard of nalaxone being used therapeutically as a pressor. It's always interesting to read about these novel therapies that sound like they work, but never make their way into routine practice for a variety of reasons.

The proposed mechanism is pretty well explained in the text of the article. Endogenous opioids (endorphins) are released as a result of ACTH stimulation in response to physiologic stress. I must admit that I never thought of this as being a factor in aggravating the hypotension that occurs during sepsis, though. Anyway, it sounds like this works for basically the same reason that you see HR and BP increase when you give naloxone to someone who isn't in shock but has taken too much opioid - you are increasing SNS stimulation by removing the inhibiting effects of the opioid.

The article itself struck me as a little odd. In a year's time at two centers they were only able to enroll 5 patients. No description of the control group or how they compared to the experimental group. 4 of the study subjects died. No improvement in eventual outcome.

 

[JPINFV]

The article itself struck me as a little odd. In a year's time at two centers they were only able to enroll 5 patients. No description of the control group or how they compared to the experimental group. 4 of the study subjects died. No improvement in eventual outcome.

I wonder if part of the problem is asking for the treatment. Granted, with an active research project ongoing, more people would know about it, but I imagine if I was in the middle of resuscitating a septic patient and called for Narcan, that I would get looked at like I had two heads.

 

[NomadicMedic]

I've seen that when there's a study ongoing, everyone who may be potentially involved knows all about how to enroll participants.

The ROC study in Seattle was exceptionally well organized, both in and out of the hospital, as was the PreHospital airway study in Eastern Washington.

 

[EMTinCT]

Possibly narcan blocks nitric oxide synthase? This causes vasodilation.

Vitamin D does the same, I think.

Just a thought. Grandma once told me to never think, but I try to from time to time.