Survival After Shock Requiring High-Dose Vasopressor Therapy
Survival After Shock Requiring High-Dose Vasopressor Therapy
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DOI：
10.1378/chest.12-1106
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发表时间：
2013-03-01
期刊：
影响因子：
9.6
通讯作者：
Morris, Alan H.
中科院分区：
文献类型：
--
作者：
Brown, Samuel M.;Lanspa, Michael J.;Morris, Alan H.
背景：有些休克患者对常规剂量的血管加压药治疗无反应。关于大剂量血管加压药治疗（HDV）的结果知之甚少。我们试图描述需要HDV的休克患者的生存率。我们还评估了可能的实用程序的压力剂量皮质类固醇治疗在这些patients.Methods：我们进行了一项回顾性研究，休克患者需要HDV在ICU的五家医院从2005年至2010年。我们将HDV定义为在任何时间点接受≥ 1 μ g/kg/min的去甲肾上腺素当量（通过将所有血管加压药的去甲肾上腺素当量输注速率相加计算）。我们报告了住院后90天的存活率。我们评估了收到的应激剂量皮质类固醇，休克的原因，收到心肺复苏术，和撤回或扣留的生命支持therapy.Results：我们确定了443例患者符合纳入标准。76例（17%）存活。241例感染性休克患者的生存率相似（20%）。在367名非幸存者中，254名（69%）经历了护理的扣留/撤回，115名（31%）接受了CPR。应激剂量皮质类固醇治疗与生存率增加相关（P= 0.01）。结论：六分之一的休克患者在HDV后存活至90天。大多数非幸存者在停止或停止生命支持治疗后死亡。少数患者接受了CPR。此外，对于需要HDV的休克患者，应激剂量皮质类固醇治疗似乎是合理的。胸部2013; 143（3）：664-671
Background: Some patients with hypotensive shock do not respond to usual doses of vasopressor therapy. Very little is known about outcomes after high-dose vasopressor therapy (HDV). We sought to characterize survival among patients with shock requiring HDV. We also evaluated the possible utility of stress-dose corticosteroid therapy in these patients.Methods: We conducted a retrospective study of patients with shock requiring HDV in the ICUs of five hospitals from 2005 through 2010. We defined HDV as receipt at any point of >= 1 mu g/kg/min of norepinephrine equivalent (calculated by summing norepinephrine-equivalent infusion rates of all vasopressors). We report survival 90 days after hospital admission. We evaluated receipt of stress-dose corticosteroids, cause of shock, receipt of CPR, and withdrawal or withholding of life support therapy.Results: We identified 443 patients meeting inclusion criteria. Seventy-six (17%) survived. Survival was similar (20%) among the 241 patients with septic shock. Among the 367 nonsurvivors, 254 (69%) experienced withholding/withdrawal of care, and 115 (31%) underwent CPR. Stress-dose corticosteroid therapy was associated with increased survival (P=.01).Conclusions: One in six patients with shock survived to 90 days after HDV. The majority of nonsurvivors died after withdrawal or withholding of life support therapy. A minority of patients underwent CPR. Additionally, stress-dose corticosteroid therapy appears reasonable in patients with shock requiring HDV. CHEST 2013; 143(3):664-671