Current use of vasopressors in septic shock
By Thomas W. L. Scheeren, J. Bakker, D. De Backer, Djillali Annane, P. Asfar, E. Boerma, M. Cecconi, A. Dubin, M. Dünser, J. Duranteau and 24 more. 2019
160 citations recorded by the source corpus.
BackgroundVasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use.MethodsFrom November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 17 questions focused on the profile of respondents, triggering factors, first choice agent, dosing, timing, targets, additional treatments, and effects of vasopressors. We investigated whether the answers complied with current guidelines. In addition, a group of 34 international ESICM experts was asked to formulate recommendations for the use of vasopressors based on 6 questions with sub-questions (total 14).ResultsA total of 839 physicians from 82 countries (65% main specialty/activity intensive care) responded. The main trigger for vasopressor use was an insufficient mean arterial pressure (MAP) response to initial fluid resuscitation (83%). The first-line vasopressor was norepinephrine (97%), targeting predominantly a MAP > 60–65 mmHg (70%), with higher targets in patients with chronic arterial hypertension (79%). The experts agreed on 10 recommendations, 9 of which were based on unanimous or strong (≥ 80%) agreement. They recommended not to delay vasopressor treatment until fluid resuscitation is completed but rather to start with norepinephrine early to achieve a target MAP of ≥ 65 mmHg.ConclusionReported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.
Subfields: Critical Care and Intensive Care Medicine, Epidemiology, Surgery
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Citations in the corpus
- Time Series Deconfounder: Estimating Treatment Effects over Time in the Presence of Hidden Confounders (2019, background): “These treatments are common in the ICU and are often used to treat patients with sepsis (Schmidt et al., 2016; Scheeren et al., 2019).”