Management of septic shock with a norepinephrine-based haemodynamic algorithm.
Management of septic shock (SS) with a norepinephrine (noradrenaline)-based haemodynamic algorithm.


BACKGROUND
The choice of the best vasopressor for haemodynamic management of septic shock is controversial. Nevertheless, very few studies have been focused on evaluating different management algorithms. The aim of this study was to evaluate the performance of a norepinephrine (NE)-based management protocol. Experience with NE as the initial vasopressor, even if not comparative, could bring relevant data for planning future trails. We also wanted to evaluate the compliance of critical care physicians and nurses with haemodynamic management protocol.


METHODS
A norepinephrine-based algorithm for the management of septic shock that commands different sequential interventions according to its requirements, was applied prospectively to 100 consecutive septic shock patients.


RESULTS
Norepinephrine was used as the first vasoactive drug in all patients with a maximum dose of 0.31+/-0.3 microg kg(-1)min(-1) and an ICU mortality of 33%. Physicians applied correctly all the steps of the algorithm in 92% of the patients. Applying the algorithm, avoided the use of pulmonary artery catheter in 31 patients and led to use of lower doses of vasoactive agents than in many other clinical experiences.


CONCLUSIONS
In conclusion, our data support extended use of an algorithm based on norepinephrine for treating septic shock patients. This is the first clinical study that uses NE as the initial vasopressor drug systematically, and although not comparative, the mortality rates adjusted to APACHE II, are comparable to other studies. It also gives support for future clinical trials comparing norepinephrine with dopamine in this setting.
Hernandez
Glenn
G
Programa de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Tercer Piso, Santiago Centro, Chile. glenn@med.puc.cl
Bruhn
Alejandro
A
Romero
Carlos
C
Javier Larrondo
Francisco
F
De La Fuente
Rene
R
Castillo
Luis
L
Bugedo
Guillermo
G
D000368:Aged; D000465:Algorithms; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D009638:Norepinephrine