Vasopressors and Mean Arterial Pressure in Septic Shock: Do We Bend the Rules for Young Adults?
Isr Med Assoc J
; 25(11): 741-746, 2023 Nov.
Article
em En
| MEDLINE
| ID: mdl-37980619
ABSTRACT
BACKGROUND:
Younger patient age and relatively good prognosis have been described as factors that may increase caregiver motivation in treating patients with septic shock in the intensive care unit (ICU).OBJECTIVES:
To examine whether clinical teams tended to achieve unnecessarily higher map arterial pressure (MAP) values in younger patients.METHODS:
We conducted a population-based retrospective cohort study of patients presenting with septic shock who were treated with noradrenaline and hospitalized in a general ICU between 2006 and 2018. The patients were classified into four age groups 18-45 (n=129), 46-60 (n=96), 61-75 (n=157), and older than 75 years (n=173). Adjusted linear mixed models and locally weighted scatterplot smoothing (LOWESS) curves were used to assess associations and potential non-linear relationships, respectively, of age group with MAP and noradrenaline dosage.RESULTS:
The cohort included 555 patients. An inverse relation was observed between average MAP value and age. Among patients aged 18-45 years, the average MAP was 4.7 mmHg higher (95% confidence interval 3.4-5.9) than among patients aged > 75 years (P-value <0.001) after adjustment for sex, death in the intensive care unit, and Sequential Organ Failure Assessment scores.CONCLUSIONS:
Among patients with septic shock, the titration of noradrenaline by staff led to a higher average MAP for younger patients. Although the MAP target is equal for all age groups, staff may administer noradrenaline treatment according to a higher target of MAP due to attitudes toward patients of different ages, despite any evidence that such practice is beneficial.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Choque Séptico
/
Pressão Arterial
Limite:
Adolescent
/
Adult
/
Humans
/
Middle aged
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article