Impact of duration of hypotension prior to norepinephrine initiation in medical intensive care unit patients with septic shock: A prospective observational study


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Abstract

PurposeTo determine the impact of duration of hypotension prior to norepinephrine initiation on outcomes in MICU patients with septic shock. We hypothesized increased duration of hypotension prior to norepinephrine initiation would be associated with an increased risk for ICU mortality.Materials and methodsWe conducted a prospective-observational study in the MICU of a single-center tertiary academic medical center. We enrolled 160 adults ≥ 18 years old with septic shock. Descriptive statistics were computed for demographic and outcome variables. Primary logistic regression analysis was adjusted for severity of illness.ResultsThe mean age of our patients was 59 years (± 17); 42% were female; the mean APACHE II score was 24.1 (± 8.0), and the mean SOFA score was 9.6 (± 4.0). Median duration of hypotension prior to norepinephrine initiation was 3.6 h (IQR 1.6–9.9). Duration of hypotension prior to norepinephrine did not increase the risk for ICU mortality (OR 1.03 per hour after hypotension, 95% CI: 0.98–1.09, p = 0.20).ConclusionDuration of hypotension less than one hour and greater than one hour prior to norepinephrine initiation in MICU patients with septic shock is not associated with an increased risk for ICU mortality.HighlightsThe optimal timing for norepinephrine (NE) initiation in septic shock is unknown.Our study evaluated duration of hypotension before NE initiation on ICU outcomes.Hourly delays to NE initiation were not associated with worse ICU outcomes.

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