Format

Send to

Choose Destination
Chest. 2013 Mar;143(3):664-671. doi: 10.1378/chest.12-1106.

Survival after shock requiring high-dose vasopressor therapy.

Author information

1
Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT; Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT.
2
Research and Evaluation, Kaiser-Permanente Southern California, Pasadena, CA.
3
Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT; Homer Warner Center for Informatics Research, Intermountain Medical Center, Murray, UT.
4
Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT.
5
Department of Pharmacy, Intermountain Medical Center, Murray, UT.
6
Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT; Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT; Division of Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT.

Abstract

BACKGROUND:

Some patients with hypotensive shock do not respond to usual doses of vasopressor therapy. Very little is known about outcomes after high-dose vasopressor therapy (HDV). We sought to characterize survival among patients with shock requiring HDV. We also evaluated the possible utility of stress-dose corticosteroid therapy in these patients.

METHODS:

We conducted a retrospective study of patients with shock requiring HDV in the ICUs of five hospitals from 2005 through 2010. We defined HDV as receipt at any point of ≥ 1 μg/kg/min of norepinephrine equivalent (calculated by summing norepinephrine-equivalent infusion rates of all vasopressors). We report survival 90 days after hospital admission. We evaluated receipt of stress-dose corticosteroids, cause of shock, receipt of CPR, and withdrawal or withholding of life support therapy.

RESULTS:

We identified 443 patients meeting inclusion criteria. Seventy-six (17%) survived. Survival was similar (20%) among the 241 patients with septic shock. Among the 367 nonsurvivors, 254 (69%) experienced withholding/withdrawal of care, and 115 (31%) underwent CPR. Stress-dose corticosteroid therapy was associated with increased survival (P = .01).

CONCLUSIONS:

One in six patients with shock survived to 90 days after HDV. The majority of nonsurvivors died after withdrawal or withholding of life support therapy. A minority of patients underwent CPR. Additionally, stress-dose corticosteroid therapy appears reasonable in patients with shock requiring HDV.

PMID:
22911566
PMCID:
PMC3590882
DOI:
10.1378/chest.12-1106
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center