PRESSOR DOSES AND PROGNOSTICS

iPhoneIcon_BigJust a short post. In fact, I am writing these first two sentences just to make the post somewhat longer. Anyway, a paper in Journal of Critical Care makes vasopressor infusion doses less abstract. The authors correlate adrenaline and noradrenaline doses in the ICU with outcomes.

The study
Observational ICU study of 166 patients who received noradrenaline or adrenaline. Patients were divided into a ‘high dose’ and a ‘low dose’ group. The low dose group never received more than 40 µg/min of either vasopressor. In the high dose group the patients received more than 40 µg/min for more than one hour during their ICU stay. ICU and hospital mortality were primary outcomes.

Results
ICU mortality in the high dose group was 84%.
ICU mortality in the low dose group was 51%
Hospital mortality in the hight dose group was 90%
Hospital mortality in the low dose group was 68%

ICU mortality in the overall ICU population, including those who didn’t receive vasopressors was 22%

Take home message
High dose vasopressor use was associated with a fourfold increase in mortality over the general ICU population. The authors point out that their outcomes were true outcomes as they ‘do not practice withdrawal of life support drugs or interventions.’ Whatever that means.

Study lives here:

J Crit Care. 2014 Feb;29(1):157-60. doi: 10.1016/j.jcrc.2013.09.004. Epub 2013 Oct 18. Does high-dose vasopressor therapy in medical intensive care patients indicate what we already suspect? Sviri S, Hashoul J, Stav I, van Heerden PV.

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6 Responses to PRESSOR DOSES AND PROGNOSTICS

  1. Jakob Mathiszig-Lee says:

    Only skimmed the paper but as it isn’t a RCT all it seems to state is that sicker patients do worse unless im missing something

  2. Viking One says:

    …not even a job for Capt Obvious….
    How can anyone seriously publish with pressordoses in mcg/min and NOT relate to bodyweight……… V1

  3. Gav says:

    Given that they do not withdraw treatment. On anyone, surely this would mean escalating doses of inotorpes are being given to the dying. This would heavily screw high inotropic doses to towards death. In another unit or country, treatment may have been withdrawn at a lower dose or not commenced in the first place.

  4. Frank Hansen says:

    Oh so the sick die more then the littel sick . How do they get in a journal

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