Francois Lamontagne1, Deborah J Cook2, Neill K J Adhikari3, Matthias Briel4, Mark Duffett5, Michelle E Kho6, Karen E A Burns7, Gordon Guyatt2, Alexis F Turgeon8, Qi Zhou9, Maureen O Meade2. 1. Centre de Recherche Clinique Étienne-Le Bel and Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada. Electronic address: francois.lamontagne@uherbrooke.ca. 2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada. 3. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 4. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland. 5. Department of Pediatrics, McMaster University, Hamilton, Canada. 6. Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore. 7. Department of Critical Care, St Michael's Hospital, Toronto, Canada. 8. Department of Anesthesiology and Centre de recherche FRSQ du CHA, Université Laval, Québec, Canada. 9. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
Abstract
INTRODUCTION: Patients with septic shock often receive intravenous vasopressor infusions, with little evidence available to guide their titration. We surveyed Canadian intensivists to document self-reported vasopressor titration strategies for patients with septic shock. METHODS: We identified Canadian intensivists caring for adult patients by merging membership lists of 3 Canadian critical care associations. We invited respondents to complete a scenario-based questionnaire to understand triggers for vasopressor use, target blood pressure values, and the influence of chronic comorbidities and acute illnesses on vasopressor prescription. RESULTS: Sixty-three percent of eligible intensivists completed our survey. Most respondents (82.6%) would frequently or always administer vasopressor therapy for isolated hypotension but not for other isolated signs of organ failure (such as elevated serum lactate or low urine output). Respondents defined low blood pressure using mean arterial pressure (83.7%) and aimed for higher values when resuscitating a patient with multiple organ failure. Chronic comorbidities and acute concurrent illnesses had variable effects on stated vasopressor prescription. Norepinephrine (94.8%) was the preferred first-line vasopressor. CONCLUSIONS: Self-reported vasopressor use for the treatment of septic shock is relatively uniform among Canadian intensivists; however, practice is variable in patients with chronic comorbidities or acute concurrent illnesses.
INTRODUCTION:Patients with septic shock often receive intravenous vasopressor infusions, with little evidence available to guide their titration. We surveyed Canadian intensivists to document self-reported vasopressor titration strategies for patients with septic shock. METHODS: We identified Canadian intensivists caring for adult patients by merging membership lists of 3 Canadian critical care associations. We invited respondents to complete a scenario-based questionnaire to understand triggers for vasopressor use, target blood pressure values, and the influence of chronic comorbidities and acute illnesses on vasopressor prescription. RESULTS: Sixty-three percent of eligible intensivists completed our survey. Most respondents (82.6%) would frequently or always administer vasopressor therapy for isolated hypotension but not for other isolated signs of organ failure (such as elevated serum lactate or low urine output). Respondents defined low blood pressure using mean arterial pressure (83.7%) and aimed for higher values when resuscitating a patient with multiple organ failure. Chronic comorbidities and acute concurrent illnesses had variable effects on stated vasopressor prescription. Norepinephrine (94.8%) was the preferred first-line vasopressor. CONCLUSIONS: Self-reported vasopressor use for the treatment of septic shock is relatively uniform among Canadian intensivists; however, practice is variable in patients with chronic comorbidities or acute concurrent illnesses.
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