title: Impact of a recent chemotherapy on the duration and intensity of the norepinephrine support during septic shock.
abstract: The objective of this study was to compare the dose and the duration of vasopressor during septic shock in recently treated cancer patients, untreated cancer patients, and patients without malignancy. This was a retrospective single-center study. This study was performed on a 12-bed medical intensive care unit at a teaching hospital. There were 147 patients admitted to the intensive care unit with septic shock: 82 cancer patients recently treated (TCPs), 20 untreated cancer patients (UCPs), and 45 without malignancy (NPs). The primary outcomes were the maximal dose and the duration of vasopressor support. Treated cancer patients were younger (P < 0.0001) and compared with NPs had less comorbidity (P = 0.003), had more frequently an intra-abdominal source of sepsis (P = 0.011), less frequently a gram-positive bacteria (P = 0.036), and a shorter delay for antibiotics (P = 0.029). All patients received norepinephrine with similar maximal doses (0.66 [0.29-1.5] µg · kg(-1) · min(-1) in TCPs vs. 0.82 [0.41-1.4] µg · kg(-1) · min(-1) in NPs and 0.79 [0.48-1.7] µg · kg(-1) · min(-1) in UCPs; P = 0.61) and duration in the three groups (2 [2-4] days in TCPs vs. 3 [2-4] days in NPs and 3 [2-5] days in UCPs; P = 0.13). Mechanical ventilation (P = 0.11), renal replacement therapy (P = 0.19), and 28-day mortality (43% in TCPs vs. 49% in NPs, and 50% in UCPs; P = 0.77) were similar between the three groups. Cancer patients recently treated with chemotherapy had similar needs in vasopressor support during septic shock compared with untreated cancer patients and patients without malignancy. Mortality was not different in cancer and noncancer patients with septic shock.
authors: Medical ICU, AP-HP, Hôpital Saint-Louis; and UFR de Médecine, University Paris-7-Paris-Diderot, Paris, France. david.shnell@sls.aphp.fr
authors: David
authors: D
authors: Schnell
authors: Sébastien
authors: S
authors: Besset
authors: Etienne
authors: E
authors: Lengliné
authors: Nicolas
authors: N
authors: Maziers
authors: Lara
authors: L
authors: Zafrani
authors: Danielle
authors: D
authors: Reuter
authors: Anne-Sophie
authors: AS
authors: Moreau
authors: Emmanuel
authors: E
authors: Canet
authors: Virginie
authors: V
authors: Lemiale
authors: Elie
authors: E
authors: Azoulay
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003422:Critical Care; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D009638:Norepinephrine / Q000008:administration & dosage*; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D061665:Time-to-Treatment; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D014662:Vasoconstrictor Agents; D009638:Norepinephrine