Arterial Pressure Response to an Increase in Norepinephrine Varies Depending on the Baseline Norepinephrine Dose in Patients With Septic Shock.
Arterial Pressure Response to an Increase in Norepinephrine Varies Depending on the Baseline Norepinephrine Dose in Patients With Septic Shock.
复制标题
动脉压对去甲肾上腺素增加的反应因感染性休克患者的基线去甲肾上腺素剂量而异。
DOI：
10.1016/j.chest.2023.05.008
复制
发表时间：
2023
期刊：
影响因子：
9.6
通讯作者：
Walkey,AllanJ
中科院分区：
文献类型：
--
作者：
Bosch,NicholasA;Teja,Bijan;Law,AnicaC;Wunsch,Hannah;Walkey,AllanJ
方法我们使用重症监护医疗信息集市-IV，3 一个去识别化的单中心数据库（2008-2019 年），收录了贝斯以色列女执事医疗中心（马萨诸塞州波士顿）入住 ICU 的患者。纳入的患者是诊断为败血症 4 的成人，开始单独使用去甲肾上腺素，剂量在 0.01（第一个百分位数）至 0.5（第 99 个百分位数）μg/kg/min 之间（重症监护 IV 医疗信息市场的 ICU 使用基于体重的剂量）。我们确定了第一个发作，结果在 34,789 名成年败血症患者中，我们确定了 5,569 名患者开始单独使用去甲肾上腺素，其中 2,903 名患者增加了去甲肾上腺素剂量。剂量增加前的平均最小 MAP 为 63 (SD, 11) mm Hg，剂量增加后的平均最大 MAP 为 72 (SD, 12) mm Hg。平均序贯器官衰竭评估评分为 7 (SD, 3)。纳入患者的其他特征如表 1 所示。最低 MAP 测量发生在去甲肾上腺素剂量增加之前大约 15 分钟。讨论使用随时间变化的电子病历数据，我们证明，对于接受去甲肾上腺素剂量高于 0.2 μg/kg/min 的感染性休克患者，随着去甲肾上腺素的增加，MAP 的增加较小。去甲肾上腺素有效性变化的潜在阈值有助于为感染性休克的临床实践提供信息，并为感染性休克辅助血管活性治疗的未来研究奠定合理的目标。
MethodsWe used Medical Information Mart for Intensive Care-IV, 3 a de-identified single-center database (2008-2019) of patients admitted to ICUs at Beth Israel Deaconess Medical Center (Boston, MA). Included patients were adults with a diagnosis of sepsis 4 who were started on norepinephrine alone at a dose between 0.01 (first percentile) and 0.5 (99th percentile) μg/kg/min (ICUs in Medical Information Mart for Intensive Care-IV used weight-based dosing). We identified the first episode whenResultsAmong 34,789 adult patients with sepsis, we identified 5,569 patients started on norepinephrine alone, of whom 2,903 had a norepinephrine dose increase. The mean minimum MAP prior to dose increase was 63 (SD, 11) mm Hg, and mean maximum MAP afterward was 72 (SD, 12) mm Hg. The mean Sequential Organ Failure Assessment score was 7 (SD, 3). Additional characteristics of included patients are shown in Table 1. Nadir MAP measurements occurred approximately 15 min before norepinephrine dose increasesDiscussionUsing time-varying electronic medical record data, we show evidence for a smaller increase in MAP in response to a norepinephrine increase for patients with septic shock receiving norepinephrine doses above 0.2 μg/kg/min. This potential threshold for a change in norepinephrine effectiveness helps to inform septic shock clinical practice and marks a rational target for future studies of adjunctive vasoactive treatments for septic shock.