Evaluation of Vasopressor Exposure and Mortality in Patients With Septic Shock.
APACHE
Adult
Aged
Aged, 80 and over
Dose-Response Relationship, Drug
Female
Fluid Therapy
/ methods
Hospital Mortality
/ trends
Humans
Intensive Care Units
/ statistics & numerical data
Male
Middle Aged
Organ Dysfunction Scores
Prospective Studies
Shock, Septic
/ drug therapy
Vasoconstrictor Agents
/ administration & dosage
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
25
7
2020
medline:
26
5
2021
entrez:
25
7
2020
Statut:
ppublish
Résumé
The objectives of this study were to: 1) determine the association between vasopressor dosing intensity during the first 6 hours and first 24 hours after the onset of septic shock and 30-day in-hospital mortality; 2) determine whether the effect of vasopressor dosing intensity varies by fluid resuscitation volume; and 3) determine whether the effect of vasopressor dosing intensity varies by dosing titration pattern. Multicenter prospective cohort study between September 2017 and February 2018. Vasopressor dosing intensity was defined as the total vasopressor dose infused across all vasopressors in norepinephrine equivalents. Thirty-three hospital sites in the United States (n = 32) and Jordan (n = 1). Consecutive adults requiring admission to the ICU with septic shock treated with greater than or equal to 1 vasopressor within 24 hours of shock onset. None. Out of 1,639 patients screened, 616 were included. Norepinephrine (93%) was the most common vasopressor. Patients received a median of 3,400 mL (interquartile range, 1,851-5,338 mL) during the 24 hours after shock diagnosis. The median vasopressor dosing intensity during the first 24 hours of shock onset was 8.5 μg/min norepinephrine equivalents (3.4-18.1 μg/min norepinephrine equivalents). In the first 6 hours, increasing vasopressor dosing intensity was associated with increased odds ratio of 30-day in-hospital mortality, with the strength of association dependent on concomitant fluid administration. Over the entire 24 hour period, every 10 μg/min increase in vasopressor dosing intensity was associated with an increased risk of 30-day mortality (adjusted odds ratio, 1.33; 95% CI, 1.16-1.53), and this association did not vary with the amount of fluid administration. Compared to an early high/late low vasopressor dosing strategy, an early low/late high or sustained high vasopressor dosing strategy was associated with higher mortality. Increasing vasopressor dosing intensity during the first 24 hours after septic shock was associated with increased mortality. This association varied with the amount of early fluid administration and the timing of vasopressor titration.
Identifiants
pubmed: 32706559
doi: 10.1097/CCM.0000000000004476
pii: 00003246-202010000-00006
doi:
Substances chimiques
Vasoconstrictor Agents
0
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1445-1453Subventions
Organisme : NCRR NIH HHS
ID : UL1 RR024140
Pays : United States
Investigateurs
Tina McCurry
(T)
Jeremy R DeGrado
(JR)
Kevin M Dube
(KM)
Kenneth E Lupi
(KE)
Andrei Hastings
(A)
Omar Mehkri
(O)
Raquel R Bartz
(RR)
Angela L Pollak
(AL)
Sarah Kendal Smith
(SK)
Marguerite Stewart
(M)
Leona Wells
(L)
Jamie Kerestes
(J)
Kayla Kotch
(K)
Sarah Miller
(S)
Brent Armbruster
(B)
Valerie Aston
(V)
Katie Brown
(K)
Mardee Merrill
(M)
Nadeen Anabtawi
(N)
Katie Nault
(K)
Kerri L Federico
(KL)
Peter-John Trapp
(PJ)
Joseph C Farmer
(JC)
Pablo Moreno Franco
(PM)
Shurong Gong
(S)
Rahul Kashyap
(R)
Sidhant Singh
(S)
Reagan D Collins
(RD)
Jorge Ataucuri-Vargas
(J)
Vladyslav Dieiev
(V)
Ashley Kang
(A)
Ann Wang
(A)
Neha N Goel
(NN)
Oscar Mitchell
(O)
Jordan DeWitt
(J)
Alex Heine
(A)
Abby Tyson
(A)
Dubier Matos
(D)
Ebaad Haq
(E)
Katie Dalton
(K)
Valentina Amaral
(V)
Jasmine Aulakh
(J)
Nauman Farooq
(N)
Kerra Cissne
(K)
Jose Camarena
(J)
Alexia Demitsas
(A)
Kristen Deupree
(K)
Karen Lutrick
(K)
Nora Elson
(N)
Dina Gomaa
(D)
John Shinn
(J)
Anthony Spuzzillo
(A)
Devin Wakefield
(D)
Mehrnaz Pajoumand
(M)
Sharon Wilson
(S)
Siu Yan
(S)
Amy Yeung
(A)
Tina Chen
(T)
Sinan Hanna
(S)
Lauren Sinko
(L)
Kassidy Malone
(K)
Deamber Piel
(D)
Chloe Skidmore
(C)
Matt Flynn
(M)
Ji Yeon Seo
(JY)
Nicole M Acquisto
(NM)
Kathryn Connor
(K)
Samantha Delibert
(S)
Christine Groth
(C)
Jeff Huntress
(J)
Gregory Kelly
(G)
Therese Makhoul
(T)
Hannah Mierzwa
(H)
Stephen Rappaport
(S)
Daisy Rios
(D)
Bethany Crouse
(B)
Michael Kenes
(M)
Shamsuddin Akhtar
(S)
Abdalla A Ammar
(AA)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
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