Current use of vasopressors in septic shock
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Current use of vasopressors in septic shock. / Scheeren, Thomas W L; Bakker, Jan; De Backer, Daniel; Annane, Djillali; Asfar, Pierre; Boerma, E Christiaan; Cecconi, Maurizio; Dubin, Arnaldo; Dünser, Martin W; Duranteau, Jacques; Gordon, Anthony C; Hamzaoui, Olfa; Hernández, Glenn; Leone, Marc; Levy, Bruno; Martin, Claude; Mebazaa, Alexandre; Monnet, Xavier; Morelli, Andrea; Payen, Didier; Pearse, Rupert; Pinsky, Michael R; Radermacher, Peter; Reuter, Daniel; Saugel, Bernd; Sakr, Yasser; Singer, Mervyn; Squara, Pierre; Vieillard-Baron, Antoine; Vignon, Philippe; Vistisen, Simon T; van der Horst, Iwan C C; Vincent, Jean-Louis; Teboul, Jean-Louis.
in: ANN INTENSIVE CARE, Jahrgang 9, Nr. 1, 30.01.2019, S. 20.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Current use of vasopressors in septic shock
AU - Scheeren, Thomas W L
AU - Bakker, Jan
AU - De Backer, Daniel
AU - Annane, Djillali
AU - Asfar, Pierre
AU - Boerma, E Christiaan
AU - Cecconi, Maurizio
AU - Dubin, Arnaldo
AU - Dünser, Martin W
AU - Duranteau, Jacques
AU - Gordon, Anthony C
AU - Hamzaoui, Olfa
AU - Hernández, Glenn
AU - Leone, Marc
AU - Levy, Bruno
AU - Martin, Claude
AU - Mebazaa, Alexandre
AU - Monnet, Xavier
AU - Morelli, Andrea
AU - Payen, Didier
AU - Pearse, Rupert
AU - Pinsky, Michael R
AU - Radermacher, Peter
AU - Reuter, Daniel
AU - Saugel, Bernd
AU - Sakr, Yasser
AU - Singer, Mervyn
AU - Squara, Pierre
AU - Vieillard-Baron, Antoine
AU - Vignon, Philippe
AU - Vistisen, Simon T
AU - van der Horst, Iwan C C
AU - Vincent, Jean-Louis
AU - Teboul, Jean-Louis
PY - 2019/1/30
Y1 - 2019/1/30
N2 - BACKGROUND: Vasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use.METHODS: From November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 17 questions focused on the profile of respondents, triggering factors, first choice agent, dosing, timing, targets, additional treatments, and effects of vasopressors. We investigated whether the answers complied with current guidelines. In addition, a group of 34 international ESICM experts was asked to formulate recommendations for the use of vasopressors based on 6 questions with sub-questions (total 14).RESULTS: A total of 839 physicians from 82 countries (65% main specialty/activity intensive care) responded. The main trigger for vasopressor use was an insufficient mean arterial pressure (MAP) response to initial fluid resuscitation (83%). The first-line vasopressor was norepinephrine (97%), targeting predominantly a MAP > 60-65 mmHg (70%), with higher targets in patients with chronic arterial hypertension (79%). The experts agreed on 10 recommendations, 9 of which were based on unanimous or strong (≥ 80%) agreement. They recommended not to delay vasopressor treatment until fluid resuscitation is completed but rather to start with norepinephrine early to achieve a target MAP of ≥ 65 mmHg.CONCLUSION: Reported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.
AB - BACKGROUND: Vasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use.METHODS: From November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 17 questions focused on the profile of respondents, triggering factors, first choice agent, dosing, timing, targets, additional treatments, and effects of vasopressors. We investigated whether the answers complied with current guidelines. In addition, a group of 34 international ESICM experts was asked to formulate recommendations for the use of vasopressors based on 6 questions with sub-questions (total 14).RESULTS: A total of 839 physicians from 82 countries (65% main specialty/activity intensive care) responded. The main trigger for vasopressor use was an insufficient mean arterial pressure (MAP) response to initial fluid resuscitation (83%). The first-line vasopressor was norepinephrine (97%), targeting predominantly a MAP > 60-65 mmHg (70%), with higher targets in patients with chronic arterial hypertension (79%). The experts agreed on 10 recommendations, 9 of which were based on unanimous or strong (≥ 80%) agreement. They recommended not to delay vasopressor treatment until fluid resuscitation is completed but rather to start with norepinephrine early to achieve a target MAP of ≥ 65 mmHg.CONCLUSION: Reported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.
U2 - 10.1186/s13613-019-0498-7
DO - 10.1186/s13613-019-0498-7
M3 - SCORING: Journal article
C2 - 30701448
VL - 9
SP - 20
JO - ANN INTENSIVE CARE
JF - ANN INTENSIVE CARE
SN - 2110-5820
IS - 1
ER -