Abstract
BackgroundDespite the dissemination of international guidelines, mortality from septic shock remains high. Norepinephrine is recommended as first-line vasopressor therapy with a target mean arterial pressure of 65 mmHg. High-dose vasopressor (HDV) may also be required. This study aimed to assess survival in patients with septic shock requiring HDV. We conducted a retrospective study of patients admitted between January 2008 and December 2013 to a 13-bed ICU for septic shock and receiving high-dose vasopressor therapy (defined by a dose >1 µg/kg/min). Primary outcome was 28-day mortality (D28). Secondary outcomes were 90-day mortality (D90), organ failure score (SOFA), duration of organ failure, duration and dosage of vasopressor agent and ischemic complications.ResultsIn our cohort of 106 patients, mortality reached 60.4% at D28 and 66.3% at D90. One in two patients died before D10. The weight-based mean dose of vasopressor (WMD) represented the best prognostic factor. Using a cutoff of 0.75 µg/kg/min, WMD was associated with mortality with a sensitivity of 73% and specificity of 74%. The mortality rate reached 86.4% when WMD was above the cutoff value and associated with a SOFA score >10. Digital or limb necrosis was documented in 6 patients (5.7%).ConclusionsIn total, 40% of septic shock patients receiving high-dose vasopressor therapy survived at day 28 after admission. A WMD cutoff value of 0.75 µg/kg/min, associated with a >10 SOFA score, was a strong predictor of death. These results provide insights into outcome of refractory septic shock, showing that administration of high-dose vasopressor may indeed be useful in these patients.
Highlights
Despite the dissemination of international guidelines, mortality from septic shock remains high
All patients who were admitted for septic shock during the study period and had received high-dose vasopressor (HDV) therapy, i.e., epinephrine or norepinephrine, were studied
Patients were excluded on the following criteria: low vasopressor dose, diagnosis of septic shock 24 h prior to intensive care unit (ICU) admission or after the first day in ICU, septic shock complicated by cardiac arrest before admission
Summary
Despite the dissemination of international guidelines, mortality from septic shock remains high. Norepinephrine is recommended as first-line vasopressor therapy with a target mean arterial pressure of 65 mmHg. High-dose vasopressor (HDV) may be required. High doses have been defined by a cutoff value ranging from 0.5 μg/kg/min to 2 μg/kg/min [14], converging evidence has recently confirmed the dose of 1 μg/kg/min [15, 16]. Mortality at these doses is substantial, from 80 to 100% [17,18,19].
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