Current use of vasopressors in septic shock.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Scheeren Thomas W L, Bakker Jan, De Backer Daniel, Annane Djillali, Asfar Pierre, Boerma E Christiaan, Cecconi Maurizio, Dubin Arnaldo, Dünser Martin W, Duranteau Jacques, Gordon Anthony C, Hamzaoui Olfa, Hernández Glenn, Leone Marc, Levy Bruno, Martin Claude, Mebazaa Alexandre, Monnet Xavier, Morelli Andrea, Payen Didier, Pearse Rupert, Pinsky Michael R, Radermacher Peter, Reuter Daniel, Saugel Bernd, Sakr Yasser, Singer Mervyn, Squara Pierre, Vieillard-Baron Antoine, Vignon Philippe, Vistisen Simon T, van der Horst Iwan C C, Vincent Jean-Louis, Teboul Jean-Louis
Аннотация
METHODS: From November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 17 questions focused on the profile of respondents, triggering factors, first choice agent, dosing, timing, targets, additional treatments, and effects of vasopressors. We investigated whether the answers complied with current guidelines. In addition, a group of 34 international ESICM experts was asked to formulate recommendations for the use of vasopressors based on 6 questions with sub-questions (total 14).
RESULTS: A total of 839 physicians from 82 countries (65% main specialty/activity intensive care) responded. The main trigger for vasopressor use was an insufficient mean arterial pressure (MAP) response to initial fluid resuscitation (83%). The first-line vasopressor was norepinephrine (97%), targeting predominantly a MAP > 60-65 mmHg (70%), with higher targets in patients with chronic arterial hypertension (79%). The experts agreed on 10 recommendations, 9 of which were based on unanimous or strong (≥ 80%) agreement. They recommended not to delay vasopressor treatment until fluid resuscitation is completed but rather to start with norepinephrine early to achieve a target MAP of ≥ 65 mmHg.
CONCLUSION: Reported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.