Central venous pressure value can assist in adjusting norepinephrine dosage after the initial resuscitation of septic shock
Background: New definitions for sepsis and septic shock (Sepsis-3) were published, but the strategy to adjust vasopressors after the initial guidelines is still unclear.We conducted a retrospective observational study to explore dosing strategy of norepinephrine (NE).Methods: A retrospective observational study in the 15-bed mixed intensive care unit of a tertiary care university hospital.The study was performed on septic shock patients after 30 mL/kg fluid resuscitation and mean arterial pressure (MAP) levels reached >65 mmHg requiring NE.We divided patients into NE dosage increase and decrease groups, and collected hemodynamic and tissue perfusion parameters before (T1) and after (T2) adjusting NE dosage.Results: In both NE increase and decrease groups, central venous pressure (CVP) and pressure difference between usual MAP and MAP (dMAP) at the T1 time point were associated with lactate clearance.In groups LC HM (CVP < 10 mmHg, dMAP > 0 mmHg) and HC HM (CVP≥10mmHg, dMAP>0mmHg), decrease in NE dosage decreased lactate level, while in group HC LM (CVP≥ 10 mmHg, dMAP≤ 0 mmHg), both increase and decrease in NE dosage led to increase lactate level.Conclusions: After patients with septic shock (Sepsis-3) resuscitated to reach the initial recovery target goals, combination of CVP and MAP refer to usual levels can help doctors make the next decision to make the correct choice of increase NE dosage or decrease NE dosage.
Septic shock Vasopressors Central venous pressure Hemodynamics
Dong-Kai Li Wei Du
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
国际会议
珠海
英文
1159-1165
2019-05-23（万方平台首次上网日期，不代表论文的发表时间）