The Relationship Between Norepinephrine Equivalent Dose of Vasopressors Within 24 Hours From the Onset of Septic Shock and In-Hospital Mortality Rate

Sato, Ryota; Duggal, Abhijit; Sacha, Gretchen L.; Rudoni, Michael; Yataco, Angel Coz; Khanna, Ashish K.; Dugar, Siddharth

doi:10.1016/j.chest.2022.07.018

Cited by 12 publications

(9 citation statements)

References 8 publications

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“…When the effect of norepinephrine on mortality is assessed (7, 9, 29), erroneous norepinephrine-dose information could both reduce and increase separation through systematic differences in RCTs, and cause misclassification of exposure (30) in observational studies, which can bias estimates toward the null.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, meta-analyses assessing dose–response effects would necessitate consistency in norepinephrine dose information. For example, combining North American (7) and French (30) patients in meta-analysis without confirming consistent norepinephrine formulations may render accurate comparison and interpretation of results unfeasible.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of total dose of norepinephrine as a single agent or, in some cases, as norepinephrine equivalence has been used as a threshold to guide clinical care, prognostication for organ system injury and mortality, and as an enrollment criterion for important randomized trials (2,(7)(8)(9)(10). Based on recent publications highlighting potential variation and lack of necessary details surrounding the reporting of norepinephrinedose formulations in research (11,12), the SCCM and ESICM commissioned a joint task force.…”

Section: Scope and Task Force Compositionmentioning

confidence: 99%

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Position Paper on the Reporting of Norepinephrine Formulations in Critical Care from the Society of Critical Care Medicine and European Society of Intensive Care Medicine Joint Task Force

Wieruszewski,

Leone,

Kaas-Hansen

et al. 2024

Critical Care Medicine

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Objectives: To provide guidance on the reporting of norepinephrine formulation labeling, reporting in publications, and use in clinical practice. Design: Review and task force position statements with necessary guidance. Setting: A series of group conference calls were conducted from August 2023 to October 2023, along with a review of the available evidence and scope of the problem. Subjects: A task force of multinational and multidisciplinary critical care experts assembled by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Interventions: The implications of a variation in norepinephrine labeled as conjugated salt (i.e., bitartrate or tartrate) or base drug in terms of effective concentration of norepinephrine were examined, and guidance was provided. Measurements and Main Results: There were significant implications for clinical care, dose calculations for enrollment in clinical trials, and results of datasets reporting maximal norepinephrine equivalents. These differences were especially important in the setting of collaborative efforts across countries with reported differences. Conclusions: A joint task force position statement was created outlining the scope of norepinephrine-dose formulation variations, and implications for research, patient safety, and clinical care. The task force advocated for a uniform norepinephrine-base formulation for global use, and offered advice aimed at appropriate stakeholders.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Scope and Task Force Compositionmentioning

confidence: 99%

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Position Paper on the Reporting of Norepinephrine Formulations in Critical Care from the Society of Critical Care Medicine and European Society of Intensive Care Medicine Joint Task Force

Wieruszewski,

Leone,

Kaas-Hansen

et al. 2024

Critical Care Medicine

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“…The maximum norepinephrine equivalent dose (NEE) was collected within 24 hours of shock onset (20,21).…”

Section: Methodsmentioning

confidence: 99%

Echocardiographic Profile of Cirrhotic Patients with Sepsis and Septic Shock: A Propensity Score Matched Case-Control Study

You,

Sato,

Chawla

et al. 2023

Preprint

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Background Our understanding of changes in hemodynamics in cirrhotic patients with sepsis and septic shock and its impact on outcomes remains limited. Our study aims to investigate differences in hemodynamic profiles using echocardiography between septic patients with and without cirrhosis. Methods This is a single-center, retrospective study of septic patients with echocardiogram within 3 days of a medical intensive care unit (MICU) admission. We compared baseline characteristics, echocardiographic parameters, and outcomes between patients with and without cirrhosis. A propensity score-matched case-control model was developed to describe the differences in hemodynamic parameters between the groups. Results 3,151 patients with sepsis and septic shock were included of which 421 (13%) had cirrhosis. In the propensity score model, cirrhotic patients had significantly higher left ventricular ejection fraction (63.4 vs. 56.2%, p < 0.001) and stroke volume (73.3 vs. 52.0 ml, p < 0.001) along with lower arterial elastance (Ea) (1.31 vs. 1.82, p < 0.001) and systemic vascular resistance (SVR) (1,110 vs. 1,370 dynes/sec/m− 5, p = 0.001). There was no difference between left ventricular elastance (Ees) (0.99 vs. 1.09, p = 0.107) and ventricular-arterial coupling (Ea/Ees) (1.29 vs. 1.40, p = 0.061). Conclusion Septic patients with cirrhosis had higher LVEF with a significantly higher percentage of hyperdynamic state than those without cirrhosis. Lower Ea and SVR without significant differences in Ees and Ea/Ees suggest vasodilation as the principal driver of the hyperdynamic profile in cirrhosis. This finding may facilitate tailored hemodynamic management focused on restoring vascular tone in cirrhotic septic patients.

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“…Exposure to supratherapeutic doses of catecholamines may not be desirable. 15,16 Almost 10 years after the impressive work by the SEPSISPAM group, we need to think of trials with appropriate patient populations, targets, and outcomes. Certainly, the concept of perfusion pressure being the difference of MAP and central venous pressure or in some cases intra-abdominal pressure is a critically important area of focus.…”

Section: Appropriate Blood Pressure Target In a Critically Ill Patientmentioning

confidence: 99%

Blood Pressure Goals in Critically Ill Patients

Rajkumar¹,

Hicks²,

Marchant

et al. 2023

Methodist DeBakey Cardiovascular Journal

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Blood pressure goals in the intensive care unit (ICU) have been extensively investigated in large datasets and have been associated with various harm thresholds at or greater than a mean pressure of 65 mm Hg. While it is difficult to perform interventional randomized trials of blood pressure in the ICU, important evidence does not support defense of a higher pressure, except in retrospective database analyses. Perfusion pressure may be a more important target than mean pressure, even more so in the vulnerable patient population. In the cardiac ICU, blood pressure targets are tailored to specific cardiac pathophysiology and patient characteristics. Generally, the goal is to maintain adequate blood pressure within a certain range to support cardiac function and to ensure end organ perfusion. Individualized targets demand the use of both invasive and noninvasive monitoring modalities and frequent titration of medications and/or mechanical circulatory support where necessary. In this review, we aim to identify appropriate blood pressure targets in the ICU, recognizing special patient populations and outlining the risk factors and predictors of end organ failure.

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The Relationship Between Norepinephrine Equivalent Dose of Vasopressors Within 24 Hours From the Onset of Septic Shock and In-Hospital Mortality Rate

Cited by 12 publications

References 8 publications

Position Paper on the Reporting of Norepinephrine Formulations in Critical Care from the Society of Critical Care Medicine and European Society of Intensive Care Medicine Joint Task Force

Position Paper on the Reporting of Norepinephrine Formulations in Critical Care from the Society of Critical Care Medicine and European Society of Intensive Care Medicine Joint Task Force

Echocardiographic Profile of Cirrhotic Patients with Sepsis and Septic Shock: A Propensity Score Matched Case-Control Study

Blood Pressure Goals in Critically Ill Patients

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