Higher Initial NE Dosing Is Associated With Faster MAP Increase in Shock Patients

Background: In shock with circulatory failure, perfusion is insufficient to maintain normal organic function. If fluid resuscitation is unsuccessful, vasopressor medications are ordered, usually norepinephrine (NE), most often with a goal mean arterial pressure (MAP) of ≥65 mm Hg. NE has a half-life of around 2.5 minutes and its pharmacodynamic profile, among ICU patients, may be affected by liver or kidney dysfunction, septic physiology, and receptor downregulation. Usually NE infusions are titrated to effect but the best initial dosing is unclear. Many ICUs begin with a dose of 0.05 to 0.1 μg/kg/min but some begin with a dose of ≤2 μg/min. Objective: To characterize MAP responses to different initial NE doses among ICU-admitted shock patients. Design: Retrospective cohort study using OneICU database. Methods: 2006 septic ICU patients, requiring NE ≥30 minutes after admission, from 7 Japanese ICUs were included. Results: Both the maximum MAP rise and15-minute rate of increase were h more...