Lesly Jurado, PharmD, BCPS, BCCCP
Clinical Pharmacist
New Hanover Regional Medical Center
Disclosure information not submitted.
Michaela Carnino
PharmD
Novant Health New Hanover Regional Medical Center, United States
Disclosure information not submitted.
Title: Adverse Events associated with High Dose Vasopressor use in Septic Shock Patients
Introduction: Norepinephrine (NE) is the first line pressor recommended by the guidelines. Its use can cause adverse drug events (ADEs) due to vasoconstriction on venous and arterial vessels. We evaluated ADEs associated with high dose therapy.
Methods: This retrospective, single center, IRB study reviewed adult patients with septic shock from August 2019-2020. Patients in Medical/Surgical Trauma Neuro ICU were included. Patients that expired, discharged from the ICU within 24 hours were excluded. Primary outcome was ADEs associated with high versus low dose pressors. ADEs were digit necrosis, organ ischemia, tachyarrhythmias. High dose was NE >0.6 mcg/kg/min, epinephrine >0.13 mcg/kg/min, with 100 kg max dosing weight. Secondary outcomes were ICU length of stay and 28-day mortality. Statistical analyses were performed with SPSS Version 21.0.
Results: Of 1,049 patients, 966 were excluded. Included 83, 55 in high and 28 in low group. Age was 65±15 in high and 66±16 in low group, p=0.46. Male patients were 45% in high and 65% in low group, p=0.97. APACHE II scores were 25 ± 6.6 in high and 24±7.5 in low group, p=0.2. SOFA scores were 11.5±3 and 9.5±2.6 (p< 0.001), in the high and low groups, respectively. ADEs were reported in 76% in high and 18% in low group, p< 0.001. Documented ADEs included digit necrosis (32% vs. 1%, p=< 0.001), organ ischemia (34% vs. 11%, p< 0.001), and tachyarrhythmias (8.5% vs. 6%, p=0.47), in high vs low dose groups, respectively. Average dose of NE in high group was 0.9 mcg/kg/min and 0.2 mcg/kg/min in low group. Vasopressin was the most common second line agent. Average ICU length of stay was 7±5 days and 7±6 days, in high and low groups, respectively (p=0.26). Average duration of mechanical ventilation was 6.6±8 days in high group and 6.6±11 days in low group (p=0.98); 28-day mortality was 80% in high and 67% in low dose group, p=0.22.
Conclusions: Patients on high-dose vasopressor therapy had higher rates of documented ADEs, as expected, with significantly higher rates of digit and organ necrosis. Tachyarrhythmias were similar between groups. This study was does not determine the clinical impact of high doses of vasopressors due to its small sample size, single center and stratification.