title: Prescribed targets for titration of vasopressors in septic shock: a retrospective cohort study.
abstract: BACKGROUND
  Without robust clinical evidence to guide titration of vasopressors in septic shock, it is unclear how dosing of these potent medications occurs. We sought to measure the proportion of vasopressor prescriptions for septic shock that were missing explicit targets and to describe the targets that we identified.
  
  
  METHODS
  We conducted a multicentre, retrospective cohort study involving 9 intensive care units (ICUs) located at 3 academic hospitals in Canada and Australia. We reviewed charts of consecutive patients aged 18 years or older who were admitted to the ICU for a presumptive diagnosis of sepsis. Other inclusion criteria were hypotension (systolic arterial pressure ≤ 90 mm Hg or mean arterial pressure [MAP] ≤ 65 mm Hg) and continuous infusion of vasopressors for at least 1 hour within the initial 48 hours of ICU stay, the period of observation for this study.
  
  
  RESULTS
  We included data from 369 patient charts. At least 1 target was specified in 99% of charts. The most common targets were MAP measurements (73%). The median initial MAP target was 65 (range 55-90) mm Hg. In multivariable regression models, hospital site and older age of the patient, but not comorbidities of the patient, were associated with MAP targets. In 40% of patients, the treating team modified the initial target at least once.
  
  
  CONCLUSIONS
  This study suggests that an explicit blood pressure target accompanies nearly every vasopressor prescription and that patient characteristics have little influence on its value. Identification of a titration strategy that will maximize benefit and minimize harm constitutes a research priority.
authors: Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que.
authors: Charles
authors: C
authors: St-Arnaud
authors: Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. ; Centre de recherche Étienne-Le Bel, Université de Sherbrooke, Sherbrooke, Que.
authors: Jean-François
authors: JF
authors: Ethier
authors: Hamilton Health Sciences, Hamilton, Ont.
authors: Cindy
authors: C
authors: Hamielec
authors: Flinders Medical Centre, Adelaide, Australia.
authors: Andrew
authors: A
authors: Bersten
authors: Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
authors: Gordon
authors: G
authors: Guyatt
authors: Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
authors: Maureen
authors: M
authors: Meade
authors: Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
authors: Qi
authors: Q
authors: Zhou
authors: Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que.
authors: Marc-André
authors: MA
authors: Leclair
authors: Flinders Medical Centre, Adelaide, Australia.
authors: Alpesh
authors: A
authors: Patel
authors: Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. ; Centre de recherche Étienne-Le Bel, Université de Sherbrooke, Sherbrooke, Que.
authors: François
authors: F
authors: Lamontagne