An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity

Kotani, Yuki; Gioia, Annamaria Di; Landoni, Giovanni; Belletti, Alessandro; Khanna, Ashish K.

doi:10.1186/s13054-023-04322-y

Cited by 22 publications

(10 citation statements)

References 44 publications

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“…In the present study, the administered dosages of norepinephrine and dopamine were inconsistent. Previous studies have shown that the drug potency of dopamine is one hundredth that of norepinephrine [34]. When evaluating the low-dose category of the present study (norepinephrine ≤ 0.1 µg/kg/min and dopamine < 5 µg/kg/min), which comprised more than 80% of the study population, norepinephrine revealed greater drug potency compared with dopamine.…”

Section: Discussionmentioning

confidence: 53%

Postoperative norepinephrine versus dopamine in patients undergoing noncardiac surgery: a propensity-matched analysis using a nationwide intensive care database

Aoki

Nakajima

Sugimura

et al. 2023

Korean J Anesthesiol

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Background: Catecholamine choices, such as norepinephrine and dopamine, for perioperative blood pressure control are essential for anesthesiologists and intensivists. However, studies in noncardiac surgery are limited. Therefore, we aimed to evaluate the effect of postoperative norepinephrine and dopamine on clinical outcomes in adult patients who underwent noncardiac surgery by analyzing a nationwide intensive care patient database. Methods:This study was a multicenter retrospective study using the Japanese Intensive care PAtient Database (JIPAD). Adult patients from the JIPAD who received norepinephrine or dopamine within 24 hours after noncardiac surgery between 2018 and 2020 were included. We compared the norepinephrine and dopamine groups using one-to-one propensity score matching analysis. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, length of hospital stay, and length of ICU stay. Results:The 6236 eligible patients from 69 ICUs were allocated to the norepinephrine group (n = 4652) or the dopamine group (n = 1584). Propensity score matching created a matched cohort of 1230 pairs. After propensity score matching, in-hospital mortality did not differ between the two groups (risk difference, 0.41%; 95% confidence interval, −1.15 to 1.96; p = 0.61). Among the secondary outcomes, only the length of ICU stay was significantly shorter in the norepinephrine group than that in the dopamine group (median length, 3 days versus 4 days, respectively; p < 0.001).

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Section: Discussionmentioning

confidence: 53%

Postoperative norepinephrine versus dopamine in patients undergoing noncardiac surgery: a propensity-matched analysis using a nationwide intensive care database

Aoki

Nakajima

Sugimura

et al. 2023

Korean J Anesthesiol

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“…The clinical implications of our results might shift the current understanding of MB as a rescue therapy [24] to an adjunctive one at earlier stages of the disease. Due to its safety profile, wider availability and lower cost than other catecholamine-sparing agents [25,26], MB could emerge as a viable therapy within a multimodal strategy to maintain MAP and improve tissue perfusion, while decreasing the risk of high-dose vasopressors [9,[27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Early adjunctive methylene blue in patients with septic shock: a randomized controlled trial

et al. 2023

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Purpose Methylene blue (MB) has been tested as a rescue therapy for patients with refractory septic shock. However, there is a lack of evidence on MB as an adjuvant therapy, its’ optimal timing, dosing and safety profile. We aimed to assess whether early adjunctive MB can reduce time to vasopressor discontinuation in patients with septic shock. Methods In this single-center randomized controlled trial, we assigned patients with septic shock according to Sepsis-3 criteria to MB or placebo. Primary outcome was time to vasopressor discontinuation at 28 days. Secondary outcomes included vasopressor-free days at 28 days, days on mechanical ventilator, length of stay in ICU and hospital, and mortality at 28 days. Results Among 91 randomized patients, forty-five were assigned to MB and 46 to placebo. The MB group had a shorter time to vasopressor discontinuation (69 h [IQR 59–83] vs 94 h [IQR 74–141]; p < 0.001), one more day of vasopressor-free days at day 28 (p = 0.008), a shorter ICU length of stay by 1.5 days (p = 0.039) and shorter hospital length of stay by 2.7 days (p = 0.027) compared to patients in the control group. Days on mechanical ventilator and mortality were similar. There were no serious adverse effects related to MB administration. Conclusion In patients with septic shock, MB initiated within 24 h reduced time to vasopressor discontinuation and increased vasopressor-free days at 28 days. It also reduced length of stay in ICU and hospital without adverse effects. Our study supports further research regarding MB in larger randomized clinical trials. Trial registration ClinicalTrials.gov registration number NCT04446871, June 25, 2020, retrospectively registered.

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“…Levosimendan has been part of VIS only in studies on adult patients and the coefficient used for its dose is disputable 13,19 . However, the controversies of conversion factors concern not only levosimendan but also other vasopressor/inotropic agents to some degree 34 …”

Section: Discussionmentioning

confidence: 99%

Vasoactive Inotropic Score compared to the sequential organ failure assessment cardiovascular score in intensive care

Pölkki

Pekkarinen

Lahtinen

et al. 2023

Acta Anaesthesiol Scand

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BackgroundThe cardiovascular component of the sequential organ failure assessment (cvSOFA) score may be outdated because of changes in intensive care. Vasoactive Inotropic Score (VIS) represents the weighted sum of vasoactive and inotropic drugs. We investigated the association of VIS with mortality in the general intensive care unit (ICU) population and studied whether replacing cvSOFA with a VIS‐based score improves the accuracy of the SOFA score as a predictor of mortality.MethodsWe studied the association of VIS during the first 24 h after ICU admission with 30‐day mortality in a retrospective study on adult medical and non‐cardiac emergency surgical patients admitted to Kuopio University Hospital ICU, Finland, in 2013–2019. We determined the area under the receiver operating characteristic curve (AUROC) for the original SOFA and for SOFAVISmax, where cvSOFA was replaced with maximum VIS (VISmax) categories.ResultsOf 8079 patients, 1107 (13%) died within 30 days. Mortality increased with increasing VISmax. AUROC was 0.813 (95% confidence interval [CI], 0.800–0.825) for original SOFA and 0.822 (95% CI: 0.810–0.834) for SOFAVISmax, p < .001.ConclusionMortality increased consistently with increasing VISmax. Replacing cvSOFA with VISmax improved the predictive accuracy of the SOFA score.

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An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity

Cited by 22 publications

References 44 publications

Postoperative norepinephrine versus dopamine in patients undergoing noncardiac surgery: a propensity-matched analysis using a nationwide intensive care database

Postoperative norepinephrine versus dopamine in patients undergoing noncardiac surgery: a propensity-matched analysis using a nationwide intensive care database

Early adjunctive methylene blue in patients with septic shock: a randomized controlled trial

Vasoactive Inotropic Score compared to the sequential organ failure assessment cardiovascular score in intensive care

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