1247: OUTCOMES ASSOCIATED WITH HIGH-DOSE NOREPINEPHRINE AT AN ACADEMIC MEDICAL CENTER

Abstract

Introduction: Maximal vasopressor dosing is driven by institutional policy and may vary between intensive care units (ICUs) within an institution. The purpose of this project was to characterize use of and evaluate outcomes associated with high-dose norepinephrine (defined as norepinephrine ≥ 1 mcg/kg/min). Methods: This was a retrospective, observational cohort study of adult ICU patients at two academic medical centers over five years. Patients who received high-dose norepinephrine for ≥ 1 hour were included. Subsequent hospitalizations were excluded. Index ICU admission was defined as the ICU admission in which patients first received high-dose norepinephrine. Results: Among 1564 included patients, 277 (17.7%) survived to hospital discharge. The majority of patients were male (58.4%) and admitted to a medicine unit (75.6%). The median (IQR) age was 63 (53-76) years and the median (IQR) weight was 81.5 (67.1-99.3) kilograms. Patients received high-dose norepinephrine for a median (IQR) duration of 6.3 (3-15.9) hours with a median (IQR) maximum norepinephrine dose of 3 (1.6-3) mcg/kg/min. Patients who survived had a lower median (IQR) age compared to non-survivors [58 (48-68) vs. 65 (55-74) years, p < 0.0001], lower median (IQR) weight [72.8 (59.8-90.7) vs. 83.3 (68.8-100.8) kilograms, p < 0.0001], and received high-dose norepinephrine for a shorter median (IQR) duration [4.7 (2-13.0) vs. 6.6 (1.8-16.9) hours, p < 0.0001]. Survivors also required lower median (IQR) maximum doses [1.8 (1.4-3) vs. 3 (2-3) mcg/kg/min, p < 0.0001]. Among 857 patients that received norepinephrine ≥ 3 mcg/kg/min, 74 (8.6%) survived. On multivariable logistic regression, the odds of in-hospital survival were higher in patients who were less than 65 years (OR 2.14, 95% CI: 1.59-2.88, p < 0.001), had a maximum norepinephrine rate < 3 mcg/kg/min (OR 3.98, 95% CI: 1.9-4.16, p < 0.001) or achieved their maximum norepinephrine rate within 24 hours of index ICU admission (OR 2.83, 95% CI: 2.09-3.85, p < 0.001). Conclusions: Nearly one-fifth of patients survived to hospital discharge following administration of norepinephrine ≥ 1 mcg/kg/min. Younger age, lower maximum norepinephrine doses, and administration of high-dose norepinephrine earlier in the ICU course was associated with increased survival.