Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study)*

Abstract

In patients with community-acquired septic shock, our data suggest that norepinephrine administration could be associated with worse outcome.

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

“…The RCT with only septic shock patients demonstrated a mortality benefit in favor of norepinephrine. 48 In contrast, a recent large cohort study suggested higher mortality in patients treated with norepinephrine. This is contrasted by observational studies that demonstrated higher mortality in patients with septic shock who were treated with dopamine.…”

Association between vasoactive-inotropic score and mortality in pediatric septic shock

“…Adult studies have also identified that high doses of vasoactive drugs are associated with poor outcome [8].…”

High-Dose Norepinephrine Treatment: Determinants of Mortality and Futility in Critically Ill Patients

“…Consequently, many intensivists do not use doses greater than 100 µg/min or 1.2 µg/kg per minute. 2,5,8,[17][18][19][20][21][22][23] Indeed, use of high doses may be futile (ie, associated with 100% mortality), as reported previously, [17][18][19]21 but currently the indicators for futility of this rescue treatment are unknown. They may vary according to underlying disease, causes of shock, and other factors.…”

“…27 Our patients had severe illnesses, and about 40% of nonsurvivors had septic shock. Other investigators 3,5,6,8,9,13,14,[16][17][18][19][21][22][23] have reported an ICU mortality rate of about 40% to 50% or greater associated survival is possible. Although neither dose and duration of norepinephrine treatment nor cause of shock contributed to prediction of death, the highdose treatment appeared futile (100% mortality) if associated with an APACHE II score greater than 40, a bicarbonate level less than 9.0 mEq/L, or an epinephrine dose of 0.25 µg/kg per minute or greater at the time of admission.…”