Catecholamine Dosing and Survival in Adult Intensive Care Unit Patients

Kastrup, Marc; Braun, J.; Kaffarnik, Magnus; Dossow-Hanfstingl, Vera von; Ahlborn, Robert; Wernecke, Klaus‐D.; Spies, Claudia

doi:10.1007/s00268-013-1926-8

Cited by 21 publications

(23 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only patients with septic shock requiring high-dose vasopressor (HDV) were included in the present study, as opposed to previous studies which included all types of shock [15, 17, 19, 22, 23]. In most instances, patients herein received norepinephrine exclusively, as recommended by the Surviving Sepsis Campaign [5].…”

Section: Discussionmentioning

confidence: 99%

“…Authors in previous studies have reported extremely high mortality rates in patients with shock and HDV, reaching upward of 94% [19]. Given the lack of common definition for refractory shock and high-dose vasopressor per se, there is considerable variability in administered dosages reported in the literature, ranging from 0.5 to 4 µg/kg/min [18, 19, 22, 24, 25]. Martin et al [16] recently established a refractory dosage of 1 µg/kg/min with a 90% mortality rate at D90.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcome of patients with septic shock and high-dose vasopressor therapy

Auchet

Régnier

Girerd

et al. 2017

Ann. Intensive Care

110

View full text Add to dashboard Cite

BackgroundDespite the dissemination of international guidelines, mortality from septic shock remains high. Norepinephrine is recommended as first-line vasopressor therapy with a target mean arterial pressure of 65 mmHg. High-dose vasopressor (HDV) may also be required. This study aimed to assess survival in patients with septic shock requiring HDV. We conducted a retrospective study of patients admitted between January 2008 and December 2013 to a 13-bed ICU for septic shock and receiving high-dose vasopressor therapy (defined by a dose >1 µg/kg/min). Primary outcome was 28-day mortality (D28). Secondary outcomes were 90-day mortality (D90), organ failure score (SOFA), duration of organ failure, duration and dosage of vasopressor agent and ischemic complications.ResultsIn our cohort of 106 patients, mortality reached 60.4% at D28 and 66.3% at D90. One in two patients died before D10. The weight-based mean dose of vasopressor (WMD) represented the best prognostic factor. Using a cutoff of 0.75 µg/kg/min, WMD was associated with mortality with a sensitivity of 73% and specificity of 74%. The mortality rate reached 86.4% when WMD was above the cutoff value and associated with a SOFA score >10. Digital or limb necrosis was documented in 6 patients (5.7%).ConclusionsIn total, 40% of septic shock patients receiving high-dose vasopressor therapy survived at day 28 after admission. A WMD cutoff value of 0.75 µg/kg/min, associated with a >10 SOFA score, was a strong predictor of death. These results provide insights into outcome of refractory septic shock, showing that administration of high-dose vasopressor may indeed be useful in these patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcome of patients with septic shock and high-dose vasopressor therapy

Auchet

Régnier

Girerd

et al. 2017

Ann. Intensive Care

110

View full text Add to dashboard Cite

show abstract

“…The principle of ‘do no harm’ needs to be balanced against the need to rescue blood pressure that would otherwise collapse instantly. The maximal NA dose is not incontrovertibly defined 2 4. Remarkably, the drug information source notes that patients in septic shock may require higher doses.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the drug dosage sections of two of the most widely accessed medical resources worldwide include the following information: (1) “Indication, hypotension, acute dose [weight-based dosing]: 0.02–1 μg/kg/min IV […]; Info: pts w/septic shock may require higher doses.” (Epocrates); and (2) “Sepsis and septic shock (weight-based dosing): Range from clinical trials: 0.01–3 μg/kg/min (Hollenberg, 2004)[…]” (Up To Date) 2 3. The evidence, criteria and reasoning for withholding further escalation of the dose (when the blood pressure continues to respond to increases in NA flow) are poorly described,4 and the relevant clinical data guiding practice are weak. A treating physician might wonder why further dosage escalations should not be attempted for a patient in whom the arterial pressure is maintained at an acceptable level with only increases in NA dosage, and who would otherwise certainly die.…”

Section: Introductionmentioning

confidence: 99%

Should the norepinephrine maximal dosage rate be greatly increased in late shock?

et al. 2016

View full text Add to dashboard Cite

Any advanced shock eventually degenerates into vasoplegia, which responds weakly to vasopressors. The highest reported norepinephrine flow rate is 3 μg/kg/min. We present the case of a young explosion victim, who was transferred in late haemorrhagic shock. Apart from usual treatment (hydration, mass transfusion protocol), single-agent norepinephrine was used to maintain a mean arterial pressure (MAP) of >60–65 mm Hg. For several hours, norepinephrine flow was 7–10 times the aforementioned (highest reported) in order to achieve our goal; during which, further hydration or transfusion would not contribute to MAP elevation. Sequential Organ Failure Assessment (SOFA) severity score was 18 (expected mortality >99%). The patient survived without underperfusion-related damage. We conclude that norepinephrine dosages could potentially be greatly increased in late shock. We must resist giving up flow escalation based on its numerical value.

show abstract

“…Unjustified blood transfusions also carry the risk of hypervolemia and transmission of infections [14] or allergic reactions [15]. There is evidence that prolonged use of catecholamines is associated with poor outcome [16]. Therefore, it is important to recognize the point when tissue perfusion has normalized, and terminate resuscitation.…”

Section: Physiological Issuesmentioning

confidence: 99%

Multimodal individualized concept of hemodynamic monitoring

Molnár

Szabó

Németh

2017

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of reviewTo discuss the pathophysiological rationale of advanced hemodynamic monitoring in the critically ill and also to highlight the importance of a multimodal, individualized approach. Recent findingsThere are several clinical studies and animal experiments evaluating, which hemodynamic endpoint should be the best target during fluid management. Recent systematic reviews and meta-analyses also investigated the effects of advanced hemodynamic endpoints targeted hemodynamic management on outcome mainly in high-risk surgical patients. Although most of these studies report positive results, this knowledge does not seem to affect our everyday practice. According to large international surveys, most physicians still rely on inappropriate indices. One of the reasons could be that target values applied in these studies can be misleading in the individual patient. Therefore, we describe the concept of an individualized approach, in which normalizing the components of oxygen delivery are put in the context of the patients' individual response by evaluating components of oxygen consumption, and organ perfusion. SummaryAdvanced hemodynamic monitoring-based management provides a number of benefits, which could be better tailored for the patients' actual needs by putting this into a multimodal, individualized approach.

show abstract

Catecholamine Dosing and Survival in Adult Intensive Care Unit Patients

Cited by 21 publications

References 45 publications

Outcome of patients with septic shock and high-dose vasopressor therapy

Outcome of patients with septic shock and high-dose vasopressor therapy

Should the norepinephrine maximal dosage rate be greatly increased in late shock?

Multimodal individualized concept of hemodynamic monitoring

Contact Info

Product

Resources

About