Current use of vasopressors in septic shock

Thomas Wl L T.W. Scheeren, Jan Bakker, Daniel De Backer, Djillali Annane, Pierre Asfar, Evert Christiaan Boerma, Maurizio Cecconi, Arnaldo Dubin, Martin Dunser, Jacques Duranteau, Anthony A.C. Gordon, Olfa Hamzaoui, Glenn Hernandez, Marc Leone, Bruno Levy, Claude Martin, Alexandre Mebazaa, Xavier Monnet, Andrea Morelli, Didier Payen, Rupert M Pearse, Michaël Pinsky, Peter Radermacher, Daniel Arnulf Reuter, Bernd Saugel, Yasser Sakr, Mervyn Singer, Pierre Squara, Antoine Vieillard-Baron, Philippe Vignon, Simon Tilma Vistisen, Iwan I.C.C. van der Horst, Jean Louis Vincent and Jean Louis Teboul

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Abstract: Background: Vasopressors 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. Methods: From 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). Results: A 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. Conclusion: Reported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.

Keywords: Arterial blood pressure; Norepinephrine; Resuscitation; Sepsis; Septic shock; Shock; Vasoactive agonists; Vasopressor (search for similar items in EconPapers)
Date: 2019-12
New Economics Papers: this item is included in nep-exp
Note: SCOPUS: ar.j
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Citations: View citations in EconPapers (1)

Published in: Annals of intensive care (2019) v.9 n° 1

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