RT Journal Article
SR Electronic
T1 Prescribed targets for titration of vasopressors in septic shock: a retrospective cohort study
JF CMAJ Open
FD Canadian Medical Association
SP E127
OP E133
DO 10.9778/cmajo.20130006
VO 1
IS 4
A1 Charles St-Arnaud
A1 Jean-François Éthier
A1 Cindy Hamielec
A1 Andrew Bersten
A1 Gordon Guyatt
A1 Maureen Meade
A1 Qi Zhou
A1 Marc-André Leclair
A1 Alpesh Patel
A1 François Lamontagne
YR 2013
UL http://www.cmajopen.ca/content/1/4/E127.abstract
AB Background Without robust clinical evidence to guide titration of vasopressors in septic shock, it is unclear how dosing of these potent medications occurs. We sought to measure the proportion of vasopressor prescriptions for septic shock that were missing explicit targets and to describe the targets that we identified. Methods We conducted a multicentre, retrospective cohort study involving 9 intensive care units (ICUs) located at 3 academic hospitals in Canada and Australia. We reviewed charts of consecutive patients aged 18 years or older who were admitted to the ICU for a presumptive diagnosis of sepsis. Other inclusion criteria were hypotension (systolic arterial pressure ≤ 90 mm Hg or mean arterial pressure [MAP] ≤ 65 mm Hg) and continuous infusion of vasopressors for at least 1 hour within the initial 48 hours of ICU stay, the period of observation for this study. Results We included data from 369 patient charts. At least 1 target was specified in 99% of charts. The most common targets were MAP measurements (73%). The median initial MAP target was 65 (range 55–90) mm Hg. In multivariable regression models, hospital site and older age of the patient, but not comorbidities of the patient, were associated with MAP targets. In 40% of patients, the treating team modified the initial target at least once. Interpretation This study suggests that an explicit blood pressure target accompanies nearly every vasopressor prescription and that patient characteristics have little influence on its value. Identification of a titration strategy that will maximize benefit and minimize harm constitutes a research priority.