About: Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis

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About: Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis Goto Sponge NotDistinct Permalink

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis
Creator	Bakker, Jan Teboul, Jean-Louis De Backer, Daniel Aldana, José Alvarez, Ingrid Calderón-Tapia, Luis Cavalcanti, Alexandre Hernandez, Glenn Manzano-Nunez, Ramiro Ospina-Tascón, Gustavo Sánchez-Ortiz, Alvaro Quiñones, Egardo Ruiz-Yucuma, Juan
Source	PMC
abstract	BACKGROUND: Optimal timing for the start of vasopressors (VP) in septic shock has not been widely studied since it is assumed that fluids must be administered in advance. We sought to evaluate whether a very early start of VP, even without completing the initial fluid loading, might impact clinical outcomes in septic shock. METHODS: A total of 337 patients with sepsis requiring VP support for at least 6 h were initially selected from a prospectively collected database in a 90-bed mixed-ICU during a 24-month period. They were classified into very-early (VE-VPs) or delayed vasopressor start (D-VPs) categories according to whether norepinephrine was initiated or not within/before the next hour of the first resuscitative fluid load. Then, VE-VPs (n = 93) patients were 1:1 propensity matched to D-VPs (n = 93) based on age; source of admission (emergency room, general wards, intensive care unit); chronic and acute comorbidities; and lactate, heart rate, systolic, and diastolic pressure at vasopressor start. A risk-adjusted Cox proportional hazard model was fitted to assess the association between VE-VPs and day 28 mortality. Finally, a sensitivity analysis was performed also including those patients requiring VP support for less than 6 h. RESULTS: Patients subjected to VE-VPs received significantly less resuscitation fluids at vasopressor starting (0[0–510] vs. 1500[650–2300] mL, p < 0.001) and during the first 8 h of resuscitation (1100[500–1900] vs. 2600[1600–3800] mL, p < 0.001), with no significant increase in acute renal failure and/or renal replacement therapy requirements. VE-VPs was related with significant lower net fluid balances 8 and 24 h after VPs. VE-VPs was also associated with a significant reduction in the risk of death compared to D-VPs (HR 0.31, CI95% 0.17–0.57, p < 0.001) at day 28. Such association was maintained after including patients receiving vasopressors for < 6 h. CONCLUSION: A very early start of vasopressor support seems to be safe, might limit the amount of fluids to resuscitate septic shock, and could lead to better clinical outcomes.
has issue date	2020-02-14(xsd:dateTime)
bibo:doi	10.1186/s13054-020-2756-3
bibo:pmid	32059682
has license	cc-by
sha1sum (hex)	ba70a3e0048ad5ceb40996cb574dd2275a45b15a
schema:url	https://doi.org/10.1186/s13054-020-2756-3
resource representing a document's title	Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis
has PubMed Central identifier	PMC7023737
has PubMed identifier	32059682
schema:publication	Crit Care
resource representing a document's body	covid:ba70a3e0048ad5ceb40996cb574dd2275a45b15a#body_text
is schema:about of	named entity 'loading' covid:arg/ba70a3e0048ad5ceb40996cb574dd2275a45b15a named entity 'Optimal' named entity 'timing' named entity 'clinical outcomes' named entity 'vasopressors' named entity 'early start' named entity 'propensity score' named entity 'vasopressor' named entity 'vasopressor' named entity 'diastolic pressure' named entity 'diabetes' named entity 'septic shock' named entity 'atrial fibrillation' named entity 'cardiac output' named entity 'UCI' named entity 'clinical outcomes' named entity 'hypotension' named entity 'early start' named entity 'end-stage renal failure' named entity 'norepinephrine' named entity 'Observational studies' named entity 'randomized trial' named entity 'cirrhosis' named entity 'vasopressors' named entity 'observational study' named entity 'Repeated measures ANOVA' named entity 'Glycemic control' named entity 'vasopressors' named entity 'clinical outcomes' named entity 'vasopressors' named entity 'vasopressor' named entity 'Vasopressor' named entity 'hyperlactatemia' named entity 'first-line therapy' named entity 'vasopressors' named entity 'hypoperfusion' named entity 'perfusion' named entity 'blood pressure' named entity 'antibiotic administration' named entity 'vasopressor' named entity 'Cox regression' named entity 'perfusion' named entity 'chronic health' named entity 'fluid resuscitation' named entity 'fluid boluses' named entity 'vasopressor' named entity 'oxygen' named entity 'clinical outcomes' named entity 'clinical outcomes' named entity 'hypotension' named entity 'fluid overload' named entity 'hypotension' named entity 'propensity scores' named entity 'tissue perfusion' named entity 'myocardial ischemia' named entity 'Colombia' named entity 'CHF' named entity 'Cali' named entity 'proportional hazard model' named entity 'splanchnic' named entity 'diastolic' named entity 'vasopressor' named entity 'vasopressors' named entity 'vasopressor' named entity 'Sequential Organ Failure Assessment Score' named entity 'vasopressor' named entity 'norepinephrine' named entity 'preload'

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