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Learning Objectives: The effect of patient weight (WT) and body mass index (BMI) on hemodynamic response to vasoactive medications is not fully understood. In titratable vasopressors, this effect is less likely a concern due to the ability to titrate dose to response, however, with the use of fixed-dose arginine vasopressin (AVP), patient WT and BMI may impact response.
Methods: This was a single center, retrospective cohort of patients who received fixed-dose AVP for septic shock for ≥6 hours with concomitant catecholamines (CA) in the medical, surgical, or neurosciences intensive care unit (ICU) at a tertiary care center. The association of WT-adjusted and BMI-adjusted AVP dose with change in CA dose and change in mean arterial pressure (MAP) were evaluated using Spearman’s correlation. Patients were further stratified by World Health Organization BMI categories to evaluate secondary outcomes.
Results: There were 938 patients included with a mean WT of 92.6 ± 35.0 kg and BMI of 32.2 ± 12.0 kg/m2. There was no correlation between WT-adjusted AVP dose and change in CA dose (r=-0.05, p = 0.13) or change in MAP (r=0.04, p = 0.31) 2 hours following initiation of AVP. Similarly, no correlation was found when evaluating change in CA dose or MAP at 6 and 12 hours following AVP initiation (all p values > 0.05). Comparable findings were observed when evaluating correlations between BMI adjusted AVP dose with change in MAP and CA dose at all time points (all p values > 0.05). BMI groupings were balanced with 238 patients (25.4%) having a BMI< 25, 254 patients (27.1%) BMI 25–30, 182 patients (19.4%) BMI 30–35, and 264 patients (28.1%) BMI> 35. The mean duration of MV and ICU length of stay were 7.18 ± 9.30 and 1.92 ± 3.58 days, respectively, with no differences observed when stratified by BMI (p = 0.59 and p = 0.83, respectively). In-hospital mortality was 64.8% and there was no difference among BMI groups (p = 0.35).
Conclusions: In this large cohort of septic shock patients, adjusting AVP dose for WT and BMI did not impact changes in CA doses or MAP. Duration of MV, ICU free days and mortality after AVP initiation were not affected by BMI.

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