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Survival after shock requiring high-dose vasopressor therapy.

ABSTRACT: 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.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 ?g/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.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).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.

SUBMITTER: Brown SM

PROVIDER: S-EPMC3590882 | biostudies-other | 2013 Mar

REPOSITORIES: biostudies-other

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Survival after shock requiring high-dose vasopressor therapy.

Brown Samuel M SM Lanspa Michael J MJ Jones Jason P JP Kuttler Kathryn G KG Li Yao Y Carlson Rick R Miller Russell R RR Hirshberg Eliotte L EL Grissom Colin K CK Morris Alan H AH

Chest 20130301 3

<h4>Background</h4>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.<h4>Methods</h4>We conducted a retrospective study of patients with shock requiring HDV in the ICUs of five hospitals from 2005 through 2010 ...[more]

PMID: 22911566

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Survival after shock requiring high-dose vasopressor therapy.

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Survival after shock requiring high-dose vasopressor therapy.

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