Shock treatment in a cohort of Scandinavian intensive care units in 2014.
Shock is common in intensive care units, and treatment includes fluids, vasopressor and/or inotropic drugs, guided by hemodynamic monitoring. The aim of this study was to identify current practice for treatment of shock in Scandinavian intensive care units.



Seven-day inception cohort study in 43 intensive care units in Scandinavia. Patients ≥ 15 years old receiving more than 4 h of cardiovascular acting drug infusion were included. The use of fluids, vasopressor and inotropic drugs, type of monitoring, and target values were recorded.



One hundred and seventy-one patients were included. At inclusion, 136/168 (81%) had received vasopressor and/or inotropic drug therapy for less than 24 h, and 143/171 (84%) had received volume loading before the onset of vasoactive drug treatment. Ringer's solution was given to 129/143 (90%) of patients and starches in 3/143 (2%) patients. Noradrenaline was the most commonly used cardiovascular acting drug, given in 168/171 (98%) of cases while dopamine was rarely used. Mean arterial pressure was considered the most important variable for hemodynamic monitoring. Invasive arterial blood pressure was monitored in 166/171 (97%) of patients, arterial pulse wave analysis in 11/171 (7%), and echocardiography in 50/171 (29%).



In this survey, Ringer's solution and noradrenaline were the most common first-line treatments in shock. The use of starches and dopamine were rare. Almost all patients were monitored with invasive arterial blood pressure, but comprehensive hemodynamic monitoring was used only in a minority of patients.
Department of Anaesthesia and Intensive Care, Centalsjukhuset Kristianstad, Kristianstad, Sweden.
M
M
Kollind
Department of Anaesthesia and Intensive Care, Hallands Sjukhus, Halmstad, Sweden.
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F
Wickbom
Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Medicine, Helsinki University Central Hospital, Helsinki, Finland.
E
E
Wilkman
Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
M S C
MS
Snäckestrand
Department of Research, Development and Education, Region of Halland, Halmstad, Sweden.
A
A
Holmén
Department of Anaesthesiology, Surgical Services and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
A
A
Oldner
Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
A
A
Perner
Intensive Care Unit, Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia.
A
A
Åneman
Department of Anaesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping University Hospital, Linköping, Sweden.
M S
MS
Chew
D015331:Cohort Studies; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic; D012769:Shock; D014662:Vasoconstrictor Agents
D014662:Vasoconstrictor Agents