title: [Use of catecholamines for shock. A continuous debate!].
abstract: BACKGROUND
  Hypotension and shocks are frequently observed in patients requiring admission in ICU. However, the optimal adrenergic support in shock is controversial.
  
  
  OBJECTIVE
  To perform a descriptive approach of the current use of catecholamine in a medico-surgical ICU in patients with schoks.
  
  
  METHODS
  Our study is prospective over 3 month period. Were included all patients admitted in our ICU during the study period's. We compared the populations with and without catecholamine, we analysed the catecholamine selected in various clinical settings and we studied the impact of the use of catecholamine on the patient outcomes.
  
  
  RESULTS
  During the study's period, 226 patients were hospitalized in our service and were the subject of this study. The median age (± SD) was of 47± 24 years. During their hospitalization in the ICU, 132 patients (58.4%) presented a shock. The cardiogenic shock and the hypovolemic shock were the most observed (37.8% and 35.6% respectively). Hundred thirty patients (57.5%) received catecholamines during their stay in ICU. Eighty four patients (64.6% of the patients having received catecholamines) had received dopamine. Sixty two patients (47.7% of the patients having received catecholamines) had received dobutamine, 63 patients (48.5%) had received epinephrine and 22 patients (16.9%) had received norepinephrine. The mean's period of catecholamines use was 5 ± 4 days. Among drugs proposed in order to manage patients with cardiogenic shock, dobutamine was chosen as the first choice agent in 62% of the cases. Among drugs proposed in order to manage patients with septic shock, Dopamine was chosen as the first choice agent in 85.7 % of the cases. In our study the patients of the class C or D in the Knauss classification are significantly predisposed to receive catecholamines during their ICU stay (OR: 5.3 ; IC 95% : 1.7 - 5.7).Moreover, the needing of catecholamine use is strongly associated with high mortality (OR: 16,8; IC 95% : 16.4 - 49.2).
  
  
  CONCLUSIONS
  The choice of catecholamines is a matter of debate for critically ill patients. The use of catecholamines is a clinical marker of severity and provider of mortality.
authors.affiliation: Department of Intensive Care, Habib Bourguiba University, Sfax, Tunisia.
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.forename: Mohamed
authors.initials: M
authors.lastname: Samet
authors.forename: Anis
authors.initials: A
authors.lastname: Chaari
authors.forename: Najla
authors.initials: N
authors.lastname: Ben Aljia
authors.forename: Mohamed Nouri
authors.initials: MN
authors.lastname: Ben Mbarek
authors.forename: Hedi
authors.initials: H
authors.lastname: Chelly
authors.forename: Hassen
authors.initials: H
authors.lastname: Dammak
authors.forename: Chokri
authors.initials: C
authors.lastname: Ben Hamida
authors.forename: Noureddine
authors.initials: N
authors.lastname: Rekik
authors.forename: Hatem
authors.initials: H
authors.lastname: Kallel
authors.forename: Mounir
authors.initials: M
authors.lastname: Bouaziz
mesh_terms: D002395:Catecholamines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012769:Shock / Q000188:drug therapy*
chemical_list: D002395:Catecholamines