Roberta Domizi1, Sara Calcinaro1, Steve Harris2, Christian Beilstein3, Christiaan Boerma4, Jean-Daniel Chiche5, Annalia D'Egidio6, Elisa Damiani7, Abele Donati8, Peter M Koetsier4, Mary P Madden9, Daniel F McAuley9, Andrea Morelli6, Paolo Pelaia7, Patrick Royer5, Manu Shankar-Hari10, Nadine Wickboldt3, Parjam Zolfaghari3, Mervyn Singer2. 1. Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, UK; Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy. 2. Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, UK; Intensive Care Unit, UCL Hospitals NHS Foundation Trust, London, UK. 3. Intensive Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK. 4. Department of Intensive Care, Medical Center Leeuwarden, The Netherlands. 5. Réanimation Médicale-Hôpital Cochin, Descartes University, Cochin Institute, Paris, France. 6. Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome "La Sapienza", Policlinico Umberto Primo, Rome, Italy. 7. Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy. 8. Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy. Electronic address: a.donati@univpm.it. 9. Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, UK. 10. Department of Intensive Care, Guy's and St Thomas NHS Foundation Trust, London, UK.
Abstract
PURPOSE: Septic shock is associated with massive release of endogenous catecholamines. Adrenergic agents may exacerbate catecholamine toxicity and contribute to poor outcomes. We sought to determine whether an association existed between tachycardia and mortality in septic shock patients requiring norepinephrine for more than 6 h despite adequate volume resuscitation. MATERIALS AND METHODS: Multicentre retrospective observational study on 730 adult patients in septic shock consecutively admitted to eight European ICUs between 2011 and 2013. Three timepoints were selected: T1 (first hour of infusion of norepinephrine), Tpeak (time of highest dose during the first 24 h of treatment), and T24 (24-h post-T1). Binary logistic regression models were constructed for the three time-points. RESULTS: Overall ICU mortality was 38.4%. Mortality was higher in those requiring high-dose (≥0.3 mcg/kg/min) versus low-dose (<0.3 mcg/kg/min) norepinephrine at T1 (53.4% vs 30.6%; p < 0.001) and T24 (61.4% vs 20.4%; p < 0.0001). Patients requiring high-dose with concurrent tachycardia had higher mortality at T1; in the low-dose group tachycardia was not associated with mortality. Resolving tachycardia (from T1 to T24) was associated with lower mortality compared to patients where tachycardia persisted (27.8% vs 46.4%; p = 0.001). CONCLUSIONS: Use of high-dose norepinephrine and concurrent tachycardia are associated with poor outcomes in septic shock.
PURPOSE:Septic shock is associated with massive release of endogenous catecholamines. Adrenergic agents may exacerbate catecholaminetoxicity and contribute to poor outcomes. We sought to determine whether an association existed between tachycardia and mortality in septic shockpatients requiring norepinephrine for more than 6 h despite adequate volume resuscitation. MATERIALS AND METHODS: Multicentre retrospective observational study on 730 adult patients in septic shock consecutively admitted to eight European ICUs between 2011 and 2013. Three timepoints were selected: T1 (first hour of infusion of norepinephrine), Tpeak (time of highest dose during the first 24 h of treatment), and T24 (24-h post-T1). Binary logistic regression models were constructed for the three time-points. RESULTS: Overall ICU mortality was 38.4%. Mortality was higher in those requiring high-dose (≥0.3 mcg/kg/min) versus low-dose (<0.3 mcg/kg/min) norepinephrine at T1 (53.4% vs 30.6%; p < 0.001) and T24 (61.4% vs 20.4%; p < 0.0001). Patients requiring high-dose with concurrent tachycardia had higher mortality at T1; in the low-dose group tachycardia was not associated with mortality. Resolving tachycardia (from T1 to T24) was associated with lower mortality compared to patients where tachycardia persisted (27.8% vs 46.4%; p = 0.001). CONCLUSIONS: Use of high-dose norepinephrine and concurrent tachycardia are associated with poor outcomes in septic shock.
Authors: Mahmoud A Ammar; Abdalla A Ammar; Patrick M Wieruszewski; Brittany D Bissell; Micah T Long; Lauren Albert; Ashish K Khanna; Gretchen L Sacha Journal: Ann Intensive Care Date: 2022-05-30 Impact factor: 10.318
Authors: Bruno Levy; Caroline Fritz; Caroline Piona; Kevin Duarte; Andrea Morelli; Philippe Guerci; Antoine Kimmoun; Nicolas Girerd Journal: Crit Care Date: 2021-01-07 Impact factor: 9.097