Selby Ashley R, Khan Nida S, Dadashian Tara, Hall Nd Ronald G
Department of Pharmacy Practice, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX 75235, USA.
J Clin Med. 2023 Feb 8;12(4):1344. doi: 10.3390/jcm12041344.
No consensus exists regarding optimal dosing of norepinephrine in septic shock. We aimed to evaluate if weight-based dosing (WBD) lead to higher norepinephrine doses when achieving goal mean arterial pressure (MAP) than non-weight-based dosing (non-WBD). This was a retrospective cohort study conducted after standardization of norepinephrine dosing within a cardiopulmonary ICU. Patients received non-WBD prior to standardization (November 2018-October 2019) and WBD afterwards (November 2019-October 2020). The primary outcome was the norepinephrine dose needed to attain goal MAP. Secondary outcomes included time to goal MAP, duration of norepinephrine therapy, duration of mechanical ventilation, and treatment-related adverse effects. A total of 189 patients were included (WBD 97; non-WBD 92). There was a significantly lower norepinephrine dose at goal MAP (WBD 0.05, IQR 0.02, 0.07; non-WBD 0.07, IQR 0.05, 0.14; < 0.005) and initial norepinephrine dose (WBD 0.02, IQR 0.01, 0.05; non-WBD 0.06, 0.04, 0.12; < 0.005) in the WBD group. No difference was observed in achievement of goal MAP (WBD 73%; non-WBD 78%; = 0.09) or time until goal MAP (WBD 18, IQR 0, 60; non-WBD 30, IQR 14, 60; = 0.84). WBD may lead to lower norepinephrine doses. Both strategies achieved goal MAP with no significant difference in time to goal.
关于脓毒性休克中去甲肾上腺素的最佳剂量，目前尚无共识。我们旨在评估基于体重的给药方式（WBD）在达到目标平均动脉压（MAP）时是否比非基于体重的给药方式（非WBD）导致更高的去甲肾上腺素剂量。这是一项在心肺重症监护病房内对去甲肾上腺素给药进行标准化后开展的回顾性队列研究。患者在标准化之前（2018年11月至2019年10月）接受非WBD，之后（2019年11月至2020年10月）接受WBD。主要结局是达到目标MAP所需的去甲肾上腺素剂量。次要结局包括达到目标MAP的时间、去甲肾上腺素治疗持续时间、机械通气持续时间以及治疗相关不良反应。总共纳入了189例患者（WBD组97例；非WBD组92例）。在目标MAP时，WBD组的去甲肾上腺素剂量显著更低（WBD组0.05，四分位间距0.02，0.07；非WBD组0.07，四分位间距0.05，0.14；<0.005），初始去甲肾上腺素剂量也更低（WBD组0.02，四分位间距0.01，0.05；非WBD组0.06，四分位间距0.04，0.12；<0.005）。在达到目标MAP方面（WBD组73%；非WBD组78%；P=0.09）或直至达到目标MAP的时间方面（WBD组18，四分位间距0，60；非WBD组30，四分位间距14，60；P=0.84）未观察到差异。WBD可能导致更低的去甲肾上腺素剂量。两种策略均能达到目标MAP，在达到目标的时间上无显著差异。
