Early versus delayed administration of norepinephrine in patients with septic shockReport as inadecuate




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Critical Care

, 18:532

First Online: 03 October 2014Received: 09 April 2014Accepted: 04 September 2014

Abstract

IntroductionThis study investigated the incidence of delayed norepinephrine administration following the onset of septic shock and its effect on hospital mortality.

MethodsWe conducted a retrospective cohort study using data from 213 adult septic shock patients treated at two general surgical intensive care units of a tertiary care hospital over a two year period. The primary outcome was 28-day mortality.

ResultsThe 28-day mortality was 37.6% overall. Among the 213 patients, a strong relationship between delayed initial norepinephrine administration and 28-day mortality was noted. The average time to initial norepinephrine administration was 3.1 ± 2.5 hours. Every 1-hour delay in norepinephrine initiation during the first 6 hours after septic shock onset was associated with a 5.3% increase in mortality. Twenty-eight day mortality rates were significantly higher when norepinephrine administration was started more than or equal to 2 hours after septic shock onset Late-NE compared to less than 2 hours Early-NE. Mean arterial pressures at 1, 2, 4, and 6 hours after septic shock onset were significantly higher and serum lactate levels at 2, 4, 6, and 8 hours were significantly lower in the Early-NE than the Late-NE group. The duration of hypotension and norepinephrine administration was significantly shorter and the quantity of norepinephrine administered in a 24-hour period was significantly less for the Early-NE group compared to the Late-NE group. The time to initial antimicrobial treatment was not significantly different between the Early-NE and Late-NE groups.

ConclusionOur results show that early administration of norepinephrine in septic shock patients is associated with an increased survival rate.

AbbreviationsAPACHEAcute Physiology and Chronic Health Evaluation

CCM-ESICM-ACCP-ATS-SISThe Society of Critical Care Medicine-the European Society of Intensive Care Medicine-the American College of Chest Physicians- the American Thoracic Society-the Surgical Infection Society

CIconfidence interval

MAPmean arterial pressure

NEnorepinephrine

ORodds ratio

SSCSurviving Sepsis Campaign

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0532-y contains supplementary material, which is available to authorized users.

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Author: Xiaowu Bai - Wenkui Yu - Wu Ji - Zhiliang Lin - Shanjun Tan - Kaipeng Duan - Yi Dong - Lin Xu - Ning Li

Source: https://link.springer.com/







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