Hitting the Vasopressor Ceiling: Finding Norepinephrine Associated Mortality in the Critically Ill.

Autor: Singer KE; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Sussman JE; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Kodali RA; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Winer LK; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Heh V; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Hanseman D; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Nomellini V; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Pritts TA; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Droege CA; Department of General Surgery, University of Cincinnati, Cincinnati Ohio., Goodman MD; Department of General Surgery, University of Cincinnati, Cincinnati Ohio. Electronic address: goodmamd@ucmail.uc.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2021 Sep; Vol. 265, pp. 139-146. Date of Electronic Publication: 2021 Apr 30.
DOI: 10.1016/j.jss.2021.03.042
Abstrakt: Background: There is no consensus on what dose of norepinephrine corresponds with futility. The purpose of this study was to investigate the maximum infusion and cumulative doses of norepinephrine associated with survival for patients in medical and surgical intensive care units (MICU and SICU).
Materials and Methods: A retrospective review was conducted of 661 critically ill patients admitted to a large academic medical center who received norepinephrine. Univariate, multivariate, and area under the curve analyses with optimal cut offs for maximum infusion rate and cumulative dosage were determined by Youden Index.
Results: The population was 54.9% male, 75.8% white, and 58.7 ± 16.1 y old with 384 (69.8%) admitted to the MICU and 166 (30.2%) admitted to the SICU, including 38 trauma patients. Inflection points in mortality were seen at 18 mcg/min and 17.6 mg. The inflection point was higher in MICU patients at 21 mcg/min and lower in SICU patients at 11 mcg/min. MICU patients also had a higher maximum cumulative dosage of 30.7 mg, compared to 2.7 mg in SICU patients. In trauma patients, norepinephrine infusions up to 5 mcg/min were associated with a 41.7% mortality rate.
Conclusion: A maximum rate of 18 mcg/min and cumulative dose of 17.6 mg were the inflection points for mortality risk in ICU patients, with SICU patients tolerating lower doses. In trauma patients, even low doses of norepinephrine were associated with higher mortality. These data suggest that MICU, SICU, and trauma patients differ in need for, response to, and outcome from escalating norepinephrine doses.
Competing Interests: Declaration of Competing Interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
(Copyright © 2021. Published by Elsevier Inc.)
Databáze: MEDLINE
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