Comparative Effectiveness of Second Vasoactive Agents in Septic Shock Refractory to Norepinephrine.
J Intensive Care Med
; 32(7): 451-459, 2017 Aug.
Article
en En
| MEDLINE
| ID: mdl-27189952
ABSTRACT
OBJECTIVE:
We aim to identify the appropriate vasoactive agent in patients with septic shock who are refractory to optimal doses of norepinephrine.METHODS:
In this retrospective observational cohort study over a 4-year period, patients who received norepinephrine within 24 hours of ICU admission and a second agent within 48 hours were enrolled.RESULTS:
Among 2640 patients screened, 234 patients were enrolled, aged 60.8 ± 17.8 years, Acute Physiology and Chronic Health Evaluation IV 98.3 ± 27.5, 81.6% mechanically ventilated, and 65.8% in-hospital mortality. Within 96 hours, 2.8 ± 1.0 vasoactive agents were administered. Fifty, 50, 66, and 68 patients received dobutamine, dopamine, phenylephrine, and vasopressin as the second agent, with crude in-hospital mortality 40.0%, 66.0%, 74.2%, and 76.5%, respectively, P < .001. Survival analysis showed a statistically significant difference in survival time by second vasoactive agent, P < .001. After adjusting for confounding variables, dobutamine showed significant decreased odds ratio (OR) for mortality compared to vasopressin OR 0.34 (95% confidence interval 0.14-0.84, P = .04). The relative risk of dying was 55.8% lower in patients receiving dobutamine versus vasopressin, P < .01.CONCLUSION:
Dobutamine is associated with decreased mortality compared to other second vasoactive agents in septic shock when norepinephrine is not sufficient. A prospective randomized trial examining the outcome impact of the second vasoactive agent is needed.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Choque Séptico
/
Vasoconstrictores
/
Vasopresinas
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Intensive Care Med
Asunto de la revista:
TERAPIA INTENSIVA
Año:
2017
Tipo del documento:
Article
País de afiliación:
Estados Unidos