Implementation of a Norepinephrine-based Protocol for Management of Septic Shock: A Pilot Feasibility Study

Catecholamine Dosing and Survival in Adult Intensive Care Unit Patients

“…Other indications for the administration of catecholamines include central‐venous oxygen saturation (ScvO 2 ) <70 % and oliguria [2]. A norepinephrine‐based algorithm, which includes different sequential interventions for the management of shock, is applied as described by Hernandez and colleagues [20]. Patients with primarily impaired cardiac function, where an inotrope like enoximone [21], dobutamine, or epinephrine is indicated early in the therapy, are excluded from this algorithm using only norepinephrine.…”

Clinical management for patients admitted to a critical care unit with severe sepsis or septic shock

“…The reason may be related to the way the subjects were recruited, purely by ICU admission diagnosis, while many other studies use different methods to recruit subjects, such as finding the discharge diagnosis by means of hospital electronic records. Within the study period, 14% of the patients died in the ICU and the 28-day mortality rate was 22%, lower ICU mortality (Hernandez et al, 2006;Phua et al, 2011) than in other studies but similar 28-day mortality rates (Whittaker et al, 2013). The lower mortality rate and differences in the male-to-female ratio may be due to methodological issues.…”

The relevance of practice misalignments to trials in transfusion medicine

“…In a hypothetical clinical trial investigating a vasopressor agent in a heterogeneous population of patients with septic shock, subjects are randomized to either a high‐ or low‐fixed drug infusion rate independent of severity of shock [9]. In this trial, randomization to widespread fixed treatment protocols independent of need creates practice misalignments (Fig.…”