Centre de Recherche Clinique Étienne-Le Bel and Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada.
J Crit Care. 2011 Oct;26(5):532.e1-532.e7. doi: 10.1016/j.jcrc.2011.01.005. Epub 2011 Mar 30.
Patients with septic shock often receive intravenous vasopressor infusions, with little evidence available to guide their titration. We surveyed Canadian intensivists to document self-reported vasopressor titration strategies for patients with septic shock.
We identified Canadian intensivists caring for adult patients by merging membership lists of 3 Canadian critical care associations. We invited respondents to complete a scenario-based questionnaire to understand triggers for vasopressor use, target blood pressure values, and the influence of chronic comorbidities and acute illnesses on vasopressor prescription.
Sixty-three percent of eligible intensivists completed our survey. Most respondents (82.6%) would frequently or always administer vasopressor therapy for isolated hypotension but not for other isolated signs of organ failure (such as elevated serum lactate or low urine output). Respondents defined low blood pressure using mean arterial pressure (83.7%) and aimed for higher values when resuscitating a patient with multiple organ failure. Chronic comorbidities and acute concurrent illnesses had variable effects on stated vasopressor prescription. Norepinephrine (94.8%) was the preferred first-line vasopressor.
Self-reported vasopressor use for the treatment of septic shock is relatively uniform among Canadian intensivists; however, practice is variable in patients with chronic comorbidities or acute concurrent illnesses.
患有感染性休克的患者通常会接受静脉血管加压素输注，但缺乏指导其滴定的证据。我们调查了加拿大重症监护医师，以记录他们报告的感染性休克患者血管加压素滴定策略。
我们通过合并 3 个加拿大重症监护协会的成员名单，确定了加拿大重症监护医师照顾的成年患者。我们邀请受访者完成基于场景的问卷调查，以了解血管加压素使用的触发因素、目标血压值，以及慢性合并症和急性疾病对血管加压素处方的影响。
63%的合格重症监护医师完成了我们的调查。大多数受访者（82.6%）会经常或总是为孤立性低血压而给予血管加压素治疗，但不会为其他孤立的器官衰竭迹象（如血清乳酸升高或尿量减少）而给予治疗。受访者使用平均动脉压（83.7%）来定义低血压，并在抢救多器官衰竭患者时设定更高的目标值。慢性合并症和急性并存疾病对血管加压素的使用有不同的影响。去甲肾上腺素（94.8%）是首选的一线血管加压素。
加拿大重症监护医师报告的感染性休克治疗中血管加压素的使用相对一致；然而，在有慢性合并症或急性并存疾病的患者中，其使用存在差异。
