Time to Lose the Weight? Comparison of Weight-based and Non-weight-based Vasopressors for Septic Shock
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 945
- 试验地点
- 1
- 主要终点
- Efficacy: Total 48-hour vasopressor exposure
研究概览
简要总结
At present, there is conflicting evidence regarding outcomes in patients with septic shock receiving weight-based vasopressor (WBVP) versus non-weight-based vasopressor (NWBVP) dosing strategies. At MCMC, a weight-based strategy is in place whereas MDMC, MMMC and MRMC currently utilize a non-weight-based dosing strategy. Obese patients (BMI > 30) receiving either strategy may potentially be receiving substantially more or less vasopressor exposure compared to their non-obese (BMI < 30) counterparts. Determining total vasopressor exposure and assessing clinical outcomes would benefit our institution and others by providing optimal vasopressor dosing strategies in obese and non-obese patients. There is a difference in clinical outcomes between patients receiving weight-based and non-weight-based vasopressor dosing strategies. There is a difference in total vasopressor exposure between obese and non-obese patients utilizing WBVP and NWBVP strategies.
详细描述
Vasopressors are a mainstay of therapy for patients with septic shock to achieve and maintain hemodynamic stability.1 Both weight-based and non-weight-based dosing recommendations exist with no clear evidence that one is better than the other.3-10 However, in light of the obesity epidemic and emerging evidence regarding the dangers of excessive catecholamine exposure, an evaluation of dosing practices is warranted. The aim of this study is to determine whether clinical outcomes differ between patients receiving weight-based and non-weight-based vasopressor dosing strategies for septic shock. This is a multicenter, retrospective chart review. Patients admitted to MDMC and MCMC from 4/1/2017-8/31/2019 will be identified through the electronic medical record utilizing ICD codes for sepsis and septic shock. Patients meeting study inclusion criteria will be analyzed as described below. Outcomes will be assessed between patients receiving WBVP and NWBVP with planned subgroup analysis in each group between patients with BMI < 30, 30-49, and > 50.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •ICU admission
- •Medical admission type
- •Received NE, epinephrine (EPI), phenylephrine (PE), or dopamine (DA) for septic shock
- •Received NE/EPI/PE/DA for > 24 hours
- •Age ≥ 18 years
排除标准
- •Non-sepsis indication for vasopressors
- •Surgical or trauma admission type
- •ICU length of stay < 24 hours
结局指标
主要结局
Efficacy: Total 48-hour vasopressor exposure
时间窗: 4/1/2017-8/31/2019
Total 48-hour vasopressor exposure (norepinephrine (NE) equivalents, mg)
Safety: Composite of in-hospital mortality, vasopressor-associated adverse events
时间窗: 4/1/2017-8/31/2019
Composite of in-hospital mortality, vasopressor-associated adverse events (arrhythmia, thrombosis)
次要结局
- Safety: in-hospital mortality, vasopressor-associated adverse events(4/1/2017-8/31/2019)
- Efficacy: Total number of vasoactive agents required to maintain mean arterial pressure(4/1/2017-8/31/2019)