Anestéziológia a intenzívna medicína 2/2018

Norepinephrine doses and mortality of critically ill patients

Rationale. If the targeted treatment of different types of shock fails to maintain adequate perfusion of the brain and splanchnicus, it is necessary as soon as possible to add to the treatment vasoactive substances. First choice vasopressor in septic shock is norepinephrine, in second line vasopressin, in the rare cases where there is no risk of arrhythmias dopamine event. adrenaline. Norepinephrine is a substance which, on the one hand, saves lives, but on the other hand, can cause problems, which increase mortality of critically ill. While the initial dose is given by different authors about 0.03-0.04 μg/kg/min, the maximal dose nor the recommended duration of administration is not uniquely determined. The objective of the work. A retrospective evaluation of the impact of the administered dose of noradrenaline (NA) within the first 6 hours, 12 hours, and during the entire period of administration on the survival of critically ill patients hospitalized in the workplace of authors. Patients. 64 patients hospitalized in 2011 in the workplace of authors, which was administered noradrenaline for septic and non septic shock. Methodology. This is an observational, non interventional study with a retrospective evaluation of the analysed data. In the workplace of the authors a set of critically ill patients who received noradrenaline in a dose to 0.1 μg/kg/min and higher than 0.1 μg/kg/min during 6 hours, to 12 hours, and throughout hospitalization and the impact of this treatment on mortality critically ill have been assessed. Results. Patients with a dose of norepinephrine higher than 0.1 μg/kg/min in first 6 hours had statistically significant higher mortality than with a dose lower than 0.1 μg/kg/min (rated with Fisher direct test, p=0.006). Norepinephrine above 0.1 μg/kg/min in first six hours was associated with a 6 times higher risk of death (HR, 95% CI 6.085 1.552; 23.849, p=0.01). Patients with a dose of norepinephrine higher than 0.1 μg/kg/min recorded throughout the hospitalization had a higher mortality rate than those with a dose 0.1 μg/kg/min (χ2=5.377, p=0.02). Total mortality of workplace was 30.4% in 2011, the mortality of the file was 74.9%. Within 5 years 16 patients from this file (25%) survived. As predictors of mortality was higher age, SOFA, APACHE II. Conclusion. The authors came to the conclusion that a dose of norepinephrine higher than 0.1 μg/kg/min for more than 6 hours had a significant impact on the mortality of critically ill patients. The total mortality of the patients hospitalized in the I. KAIM was 30.4% in 2011, mortality of the file of patients who received norepinephrine was 74.9%. Within 5 years 25% of the patients survived.

Keywords: critically ill, shock, vasopressors, norepinephrine, mortality