Implementation and Evaluation of Weight-Based Vasopressors in Intensive Care Units

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-12-15 DOI:10.1177/87551225231217905

Laurie DeMillard, Michael Thuyns

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引用次数: 0

Abstract

Background: Vasopressors, including norepinephrine, epinephrine, and phenylephrine are commonly used to maintain mean arterial pressure (MAP) in critically ill patients. Despite their frequent use, the optimal dosing strategy for vasopressors remains understudied. Objective: The purpose of this study is to evaluate the implementation of a weight-based (WB) dosing strategy using ideal body weight compared to a non-weight-based (NWB) dosing strategy for vasopressors in critically ill patients. Methods: This is a retrospective chart review of patients admitted to intensive care units receiving vasopressor medications for greater than or equal to 4 hours. Patients received either an NWB or a WB vasopressor dosing strategy. The primary endpoint was the time to achieve goal MAP. Results: This study included 153 patients in the NWB vasopressor dosing group and 183 in the WB dosing group. The median time to achieve goal MAP in the NWB group was 24 minutes versus 21 minutes in the WB group ( P = 0.1713). There were no significant differences in secondary outcomes including number of vasoactive agents required, hospital length of stay, and duration of mechanical ventilation. Subgroup analysis of patients with extremes of body mass index did not show a difference in time to achieve goal MAP. In a subgroup analysis of patients with septic shock, a higher percentage of patients in the WB group received corticosteroids than the NWB group patients (14% vs. 54%; P ≤ 0.001). Conclusion and relevance: There was no difference in time to achieve goal MAP when using a WB or NWB vasopressor dosing approach. Institutions should employ a consistent dosing strategy for vasopressors with either an NWB or WB approach.

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在重症监护病房实施和评估基于体重的血管加压器

背景：血管加压药（包括去甲肾上腺素、肾上腺素和苯肾上腺素）常用于维持重症患者的平均动脉压（MAP）。尽管血管加压药使用频繁，但其最佳剂量策略仍未得到充分研究。研究目的本研究旨在评估重症患者使用血管加压药时，基于体重（WB）的理想体重给药策略与非基于体重（NWB）的给药策略的实施情况。方法：这是对重症监护病房收治的接受血管加压药物治疗超过或等于 4 小时的患者进行的回顾性病历审查。患者接受的是 NWB 或 WB 血管加压药剂量策略。主要终点是达到目标 MAP 的时间。研究结果该研究的 NWB 加压剂给药组和 WB 给药组分别有 153 名和 183 名患者。NWB 组达到目标 MAP 的中位时间为 24 分钟，而 WB 组为 21 分钟（P = 0.1713）。在次要结果方面，包括所需血管活性药物的数量、住院时间和机械通气持续时间，两组之间没有明显差异。对体重指数极端的患者进行的亚组分析表明，达到目标 MAP 的时间没有差异。在对脓毒性休克患者进行的亚组分析中，WB 组患者接受皮质类固醇治疗的比例高于 NWB 组患者（14% 对 54%；P ≤ 0.001）。结论和意义：使用 WB 或 NWB 血管抑制剂剂量方法时，达到目标 MAP 的时间没有差异。医疗机构应采用一致的剂量策略，使用 NWB 或 WB 法使用血管加压药。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.