Prognosis of patients with shock receiving vasopressors

Abstract

BACKGROUND: Consensus guidelines suggested that both dopamine and norepinephrine may be used, but specific doses are not recommended. The aim of this study is to determine the predictive role of vasopressors in patients with shock in intensive care unit. METHODS: One hundred and twenty-two patients, who had received vasopressors for 1 hour or more in intensive care unit (ICU) between October 2008 and October 2011, were included.There were 85 men and 37 women, with a median age of 65 years (55-73 years). Their clinical data were retrospectively collected and analyzed. RESULTS: The median simplified acute physiological score 3 (SAPS 3) was 50 (42-55). Multivariate analysis showed that septic shock (P=0.018, relative risk: 4.094; 95% confi dential interval: 1.274-13.156), SAPS 3 score at ICU admission (P=0.028, relative risk: 1.079; 95% confidential interval: 1.008-1.155), and norepinephrine administration (P<0.001, relative risk: 9.353; 95% confidential interval: 2.667-32.807) were independent predictors of ICU death. Receiver operating characteristic curve analysis demonstrated that administration of norepinephrine ≥0.7 μg/kg per minute resulted in a sensitivity of 75.9% and a specifi city of 90.3% for the likelihood of ICU death. In patients who received norepinephrine ≥0.7 μg/kg per minute there was more ICU death (71.4% vs. 44.8%) and in-hospital death (76.2% vs. 48.3%) than in those who received norepinephrine <0.7 μg/kg per minute. These patients had also a decreased 510-day survival rate compared with those who received norepinephrine <0.7 μg/kg per minute (19.2% vs. 64.2%). CONCLUSION: Septic shock, SAPS 3 score at ICU admission, and norepinephrine administration were independent predictors of ICU death for patients with shock. Patients who received norepinephrine ≥0.7 μg/kg per minute had an increased ICU mortality, an increased inhospital mortality, and a decreased 510-day survival rate.

High-Dose Vasopressor Therapy for Pediatric Septic Shock: When Is Too Much?

“…7 Studies in ICU patients using highdose of vasopressors revealed, in relation to mortality, values of sensitivity between 73.3 and 96% and specificity between 75.4 and 90.3%. 8,10,26 On one hand, considering the not so high sensitivity value of 75%, the threshold of 1.3 µg/kg/min of vasopressor dose should be used with caution as a screening tool to assess PICU mortality in children with septic shock. On the other hand, the high specificity value (89%) of the requirement of HDV (>1.3 µg/kg/min) denotes that if these patients do not need to receive such high doses they are less likely to die.…”

Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency

“…[10] Shock was defined as mean blood pressure being less than 65 mmHg despite an adequate amount of fluids (at least 1 000 mL of crystalloids or 500 mL of colloids) had been administered. [11] Acute kidney injury was defined as an absolute increase of serum creatinine by ≥0.3 mg/ dL (≥26.4 μmol/L), an increase of serum creatinine by ≥50%, or a reduction of urine output, i.e. <0.5 mL/ kg per hour, for more than 6 hours.…”

Isoproterenol Disrupts Intestinal Barriers Activating Gut-Liver-Axis: Effects on Intestinal Mucus and Vascular Barrier as Entry Sites

“…These patients are routinely treated with catecholamines intravenously as vasopressors aiming to stabilize arterial blood pressure and preserving organ perfusion via their cardiovascular actions (mainly α1-adrenoreceptor (AR) mediated splanchnic vasoconstriction and β1/2-AR-induced chrono-, ino-dromotropic cardiac effects). Hence, the use of norepinephrine recommended as first-line treatment is [14], but its administration has also been observed as an independent predictor of death, particularly at high doses [15]. In fact, norepinephrine application has been proposed to exert detrimental effects on the gut, for example, increase in enterocyte damage [16,17].…”