Does body weight impact the efficacy of vasopressin therapy in the management of septic shock?
Does body weight impact the efficacy of vasopressin therapy in the management of septic shock?
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DOI：
10.1016/j.jcrc.2011.06.018
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发表时间：
2012-06-01
影响因子：
3.7
通讯作者：
Alaniz, Cesar
中科院分区：
文献类型：
--
作者：
Miller, James T.;Welage, Lynda S.;Alaniz, Cesar
背景：用于治疗感染性休克的血管加压药通常根据体重给药。使用加压素对感染性休克患者进行生理替代通常按标准的非体重剂量进行。我们假设加压素的功效可能会受到体重的影响。目的：主要目的是确定加压素对其他加压素剂量需求的影响是否与体重相关。次要目标包括开始输注加压素后评估血压和心率。方法：在一家大型学术健康中心进行了一项回顾性队列研究。纳入了 64 名需要血管加压药（包括加压素治疗）的脓毒性休克成年住院患者（26 名内科重症监护病房和 38 名外科重症监护病房）。血管加压素开始前 1 小时、开始期间以及 2 小时和 4 小时后记录血管加压素的剂量要求。研究期间收集的其他信息包括血压、平均动脉压和心率。结果：大多数患者 (n = 61) 接受剂量为 0.04 U/min 的加压素。 2 小时（相关系数 = -0.36，P = .03）和 4 小时（相关系数 = -0.46，P < .001）时，升压药剂量的变化与体重调整后的升压素显着相关。与基线相比，使用加压素与每个时间点的收缩压、舒张压和平均动脉压显着升高相关。结论：在感染性休克的情况下，加压素对儿茶酚胺剂量需求的影响可能受到体重的影响。需要进行前瞻性研究来检验在这种情况下基于体重的加压素剂量。 (C) 2012 Elsevier Inc. 保留所有权利。
Background: Vasopressors used for the management of septic shock are often dosed according to body weight. Use of vasopressin for physiologic replacement in patients with septic shock is usually administered as a standard non-weight-based dose. We hypothesized that the efficacy of vasopressin may be influenced by body weight.Purpose: The primary objective was to determine if the effects of vasopressin on other vasopressor dosing requirements is related to body weight. Secondary objectives included evaluation of blood pressure and heart rate after the start of vasopressin infusion.Methods: A retrospective, cohort study in a large academic health center was conducted. Sixty-four adult inpatients with septic shock (26 medical intensive care unit and 38 surgical intensive care unit) who required vasopressor administration including vasopressin therapy were included. Dosing requirements of vasopressors were captured 1 hour before and during the hour of vasopressin initiation and 2 and 4 hours later. Other information collected during the study period included blood pressure, mean arterial pressure, and heart rate.Results: Most of the patients (n = 61) received vasopressin at a dose of 0.04 U/min. Changes in vasopressor dosing were significantly correlated with weight-adjusted vasopressin at 2 hours (correlation coefficient = -0.36, P = .03) and 4 hours (correlation coefficient = -0.46, P < .001). Use of vasopressin was associated with significant increases in systolic blood pressure, diastolic blood pressure, and mean arterial pressure at each time point compared with baseline.Conclusions: Effects of vasopressin on catecholamine dosing requirements in the setting of septic shock may be influenced by body weight. Prospective studies are needed to examine weight-based dosing of vasopressin in this setting. (C) 2012 Elsevier Inc. All rights reserved.