Impact of high-dose norepinephrine during intra-hospital damage control resuscitation of traumatic haemorrhagic shock: A propensity-score analysis
| Autor: | Julien Bordes, Aurélien Renard, Pierre Esnault, Jean Cotte, C. Nguyen, Pierre-Julien Cungi, Eric Meaudre, Bertrand Prunet, Mickael Cardinale, A. Montcriol |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Resuscitation Multiple Organ Failure Shock Hemorrhagic Norepinephrine (medication) Norepinephrine 03 medical and health sciences 0302 clinical medicine Hypovolemia medicine Humans Shock Traumatic Prospective Studies Propensity Score General Environmental Science 030222 orthopedics Dose-Response Relationship Drug business.industry Organ dysfunction 030208 emergency & critical care medicine Middle Aged Hospitalization Logistic Models Blood pressure Anesthesia Shock (circulatory) Propensity score matching Fluid Therapy General Earth and Planetary Sciences Female SOFA score medicine.symptom business medicine.drug |
| Zdroj: | Injury. 51:1164-1171 |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2019.11.037 |
| Popis: | The use of norepinephrine (NE) during uncontrolled haemorrhagic shock (HS) has mostly been investigated in experimental studies. Clinical data including norepinephrine dose and its impact on fluid resuscitation and organ function are scarce. We hypothesized that there is great variability in NE use and that high doses of NE could lead to increased organ dysfunction as measured by the sequential organ failure assessment (SOFA).We included patients with HS (systolic blood pressure90 mmHg in severely injured patients) who required haemostasis surgery and a transfusion of more than 4 packed red blood cells (PRBC) in the first 6 h of admission and the used of norepinephrine infusion to maintain the blood pressure goal, between admission and the end of haemostasis surgery in a prospective trauma database. A ROC curve determined that, using Youden's criterion, a dose of NE ≥ 0.6 µg/kg/min was the optimal threshold associated with intrahospital mortality. Patients were compared according to this threshold in a propensity score (PS) model. In a generalized linear mixed model, we searched for independent factors associated with a SOFA ≥ 9 at 24 h RESULTS: A total of 89 patients were analysed. Fluid infusion rate ranged from 1.43 to 57.9 mL/kg/h and norepinephrine infusion rate from 0.1 to 2.8 µg/kg/min. The HDNE group received significantly less fluid than the LDNE group. This dose is associated with a higher SOFA score at 24h: 9 (7-10) vs. 7 (6-9) (p = 0.003). Factors independently associated with a SOFA score ≥ 9 at 24 h were maximal norepinephrine rate ≥ 0.6 µg/kg/min (OR 6.69, 95% CI 1.82 - 25.54; p = 0.004), non-blood resuscitation volume9 mL/kg/h (OR 3.98, 95% CI 1.14 - 13.95; p = 0.031) and lactate at admission ≥ 5 mmol/L (OR 5.27, 95% CI 1.48 - 18.77; p = 0.010) CONCLUSION: High dose of norepinephrine infusion is associated with deleterious effects as attested by a higher SOFA score at 24 h and likely hypovolemia as measured by reduced non-blood resuscitation volume. We did not find any significant difference in mortality over the long term. |
| Databáze: | OpenAIRE |
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