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Current use of vasopressors in septic shock

Authors
  • Scheeren, Thomas W. L.1
  • Bakker, Jan2, 3, 4, 5
  • De Backer, Daniel6
  • Annane, Djillali7
  • Asfar, Pierre8
  • Boerma, E. Christiaan9
  • Cecconi, Maurizio10
  • Dubin, Arnaldo11
  • Dünser, Martin W.12
  • Duranteau, Jacques13
  • Gordon, Anthony C.14
  • Hamzaoui, Olfa15
  • Hernández, Glenn16
  • Leone, Marc17
  • Levy, Bruno18
  • Martin, Claude17
  • Mebazaa, Alexandre19
  • Monnet, Xavier20, 21
  • Morelli, Andrea22
  • Payen, Didier23
  • And 14 more
  • 1 University of Groningen, Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700RB, The Netherlands , Groningen (Netherlands)
  • 2 New York University Medical Center, New York, USA , New York (United States)
  • 3 Columbia University Medical Center, New York, USA , New York (United States)
  • 4 Erasmus MC University Medical Center, Rotterdam, Netherlands , Rotterdam (Netherlands)
  • 5 Pontificia Universidad Católica de Chile, Santiago, Chile , Santiago (Chile)
  • 6 Université Libre de Bruxelles, Department of Intensive Care, CHIREC Hospitals, Brussels, Belgium , Brussels (Belgium)
  • 7 University of Versailles-University Paris Saclay, Department of Intensive Care Medicine, School of Medicine Simone Veil, Raymond Poincaré Hospital (APHP), 104 boulevard Raymond Poincaré, Garches, 92380, France , Garches (France)
  • 8 Angers University, Département de Médecine Intensive-Réanimation et de Médecine Hyperbare, Centre Hospitalier Universitaire Angers, Institut MITOVASC, CNRS, UMR 6214, INSERM U1083, Angers, France , Angers (France)
  • 9 Medical Centre Leeuwarden, Department of Intensive Care, Leeuwarden, The Netherlands , Leeuwarden (Netherlands)
  • 10 Humanitas Research Hospital and Humanitas University, Department of Anaesthesia and Intensive Care Units, Milan, Italy , Milan (Italy)
  • 11 Universidad Nacional de La Plata y Servicio de Terapia Intensiva, Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Sanatorio Otamendi, Buenos Aires, Argentina , Buenos Aires (Argentina)
  • 12 Kepler University Hospital and Johannes Kepler University Linz, Department of Anesthesiology and Intensive Care Medicine, Linz, Austria , Linz (Austria)
  • 13 Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Department of Anaesthesia and Intensive Care, Le Kremlin-Bicêtre, France , Le Kremlin-Bicêtre (France)
  • 14 Imperial College London, Section of Anaesthetics, Pain Medicine and Intensive Care, London, UK , London (United Kingdom)
  • 15 Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris Paris-Sud University Hospitals, Intensive Care Unit, Clamart, France , Clamart (France)
  • 16 Pontificia Universidad Católica de Chile, Departamento de Medicina Intensiva, Facultad de Medicina, Santiago, Chile , Santiago (Chile)
  • 17 Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Service d’Anesthésie et de Réanimation CHU Nord, Marseille, France , Marseille (France)
  • 18 Université de Lorraine, Service de Réanimation Médicale Brabois et pôle cardio-médico-chirurgical, CHRU, INSERM U1116, Brabois, Vandoeuvre les Nancy, 54500, France , Vandoeuvre les Nancy (France)
  • 19 Université Paris Diderot, Department of Anesthesia, Burn and Critical Care, APHP Hôpitaux Universitaires Saint Louis Lariboisière, U942 Inserm, Paris, France , Paris (France)
  • 20 Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University Hospitals, Medical Intensive Care Unit, Le Kremlin-Bicêtre, France , Le Kremlin-Bicêtre (France)
  • 21 Paris-Saclay University, INSERM UMR_S 999, Le Plessis-Robinson, France , Le Plessis-Robinson (France)
  • 22 University of Rome “La Sapienza”, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Rome, Italy , Rome (Italy)
  • 23 University Paris 7 Denis Diderot, INSERM 1160 and Hôpital Lariboisière, APHP, Paris, France , Paris (France)
  • 24 Queen Mary University of London, London, UK , London (United Kingdom)
  • 25 University of Pittsburgh, Department of Critical Care Medicine, Pittsburgh, USA , Pittsburgh (United States)
  • 26 Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Ulm, Germany , Ulm (Germany)
  • 27 Rostock University Medical Centre, Department of Anesthesiology and Intensive Care Medicine, Rostock, Germany , Rostock (Germany)
  • 28 University Medical Center Hamburg-Eppendorf, Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, Hamburg, Germany , Hamburg (Germany)
  • 29 Uniklinikum Jena, Department of Anesthesiology and Intensive Care, Jena, Germany , Jena (Germany)
  • 30 University College London, Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, London, UK , London (United Kingdom)
  • 31 Clinique Ambroise Paré, ICU Department, Réanimation CERIC, Neuilly, France , Neuilly (France)
  • 32 University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Intensive Care Unit, Boulogne-Billancourt, France , Boulogne-Billancourt (France)
  • 33 University of Versailles Saint-Quentin en Yvelines, INSERM U-1018, CESP, Team 5, Villejuif, France , Villejuif (France)
  • 34 University of Limoges, Medical-Surgical Intensive Care Unit, INSERM CIC-1435, Teaching Hospital of Limoges, Limoges, France , Limoges (France)
  • 35 Aarhus University, Institute of Clinical Medicine, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark , Aarhus N (Denmark)
  • 36 University of Groningen, Department of Critical Care, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands , Groningen (Netherlands)
  • 37 Université Libre de Bruxelles, Department of Intensive Care, Erasme University Hospital, Brussels, Belgium , Brussels (Belgium)
  • 38 Hôpitaux Universitaires Paris-Sud, Service de Réanimation Médicale, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France , Le Kremlin-Bicêtre (France)
Type
Published Article
Journal
Annals of Intensive Care
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Jan 30, 2019
Volume
9
Issue
1
Identifiers
DOI: 10.1186/s13613-019-0498-7
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundVasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use.MethodsFrom 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).ResultsA 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.ConclusionReported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.

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