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Multicenter Study
. 2013 Mar;143(3):664-671.
doi: 10.1378/chest.12-1106.

Survival after shock requiring high-dose vasopressor therapy

Samuel M Brown  1 , Michael J Lanspa  1 , Jason P Jones  2 , Kathryn G Kuttler  3 , Yao Li  4 , Rick Carlson  5 , Russell R Miller 3rd  1 , Eliotte L Hirshberg  6 , Colin K Grissom  1 , Alan H Morris  1
Affiliations
Multicenter Study

Survival after shock requiring high-dose vasopressor therapy

Samuel M Brown et al. Chest. 2013 Mar.

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.

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Figures

Figure 1.
Figure 1.
Flow chart representing patient selection process and diagnostic categories. HDV = high-dose vasopressor therapy.
Figure 2.
Figure 2.
Effect plots for predictors included in final regression model. Plots depict relationship between predictor and mortality, with all other predictors held constant. Black line indicates effect estimate, dashed gray lines indicate 95% CIs for effect estimate. APACHE = Acute Physiology and Chronic Health Evaluation.
See this image and copyright information in PMC

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