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Current use of vasopressors in septic shock

Scheeren, T. W. L., Bakker, J., De Backer, D., Annane, D., Asfar, P., Boerma, E. C., Cecconi, M., Duebin, A., Dunser, M. W., Duranteau, J., Gordon, A. C., Hamzaoui, O., Hernandez, G., Leone, M., Levy, B., Martin, C., Mebazaa, A., Monnet, X., Morelli, A., Payen, D., Pearse, R., Pinsky, M. R., Radermacher, P., Reuter, D., Saugel, B., Sakr, Y., Singer, M., Squara, P., Vieillard-Baron, A., Vignon, P., Vistisen, S. T., van der Horst, I. C. C., Vincent, J-L. & Teboul, J-L., 30-Jan-2019, In : Annals of Intensive Care. 9, 12 p., 20.

Research output: Contribution to journalArticleAcademicpeer-review

  • Thomas W. L. Scheeren
  • Jan Bakker
  • Daniel De Backer
  • Djillali Annane
  • Pierre Asfar
  • E. Christiaan Boerma
  • Maurizio Cecconi
  • Arnaldo Duebin
  • Martin W. Dunser
  • Jacques Duranteau
  • Anthony C. Gordon
  • Olfa Hamzaoui
  • Glenn Hernandez
  • Marc Leone
  • Bruno Levy
  • Claude Martin
  • Alexandre Mebazaa
  • Xavier Monnet
  • Andrea Morelli
  • Didier Payen
  • Rupert Pearse
  • Michael R. Pinsky
  • Peter Radermacher
  • Daniel Reuter
  • Bernd Saugel
  • Yasser Sakr
  • Mervyn Singer
  • Pierre Squara
  • Antoine Vieillard-Baron
  • Philippe Vignon
  • Simon T. Vistisen
  • Iwan C. C. van der Horst
  • Jean-Louis Vincent
  • Jean-Louis Teboul

BackgroundVasopressors 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.MethodsFrom 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).ResultsA 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>60-65mmHg (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 of65mmHg.ConclusionReported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.

Original languageEnglish
Article number20
Number of pages12
JournalAnnals of Intensive Care
Volume9
Publication statusPublished - 30-Jan-2019

    Keywords

  • Shock, Sepsis, Septic shock, Resuscitation, Vasopressor, Vasoactive agonists, Norepinephrine, Arterial blood pressure, BLOOD-PRESSURE TARGETS, CAMPAIGN INTERNATIONAL GUIDELINES, INTENSIVE-CARE UNITS, TISSUE OXYGENATION, VASOACTIVE AGENTS, NOREPINEPHRINE, THERAPY, SEPSIS, MANAGEMENT, MULTICENTER

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